title: The effects of stage divergence on survival after radical cystectomy for urothelial cancer.
abstract: BACKGROUND
  Discrepancies between clinical and pathologic staging, herein referred to as stage divergence, are common after radical cystectomy. The implications of stage divergence on survival are ill defined in the context of those treated by surgery alone and would facilitate patient counseling and enhance prognostication.
  
  
  METHODS
  There were 78 consecutive radical cystectomy patients with clinical stage T2 or less urothelial carcinoma who comprised our study population. Kaplan-Meier plots were constructed to determine the effects of stage divergence on survival and the log-rank test employed to assess the significance. Regression models were developed to determine predictors of overall and cancer-specific survival.
  
  
  RESULTS
  Stage divergence was common after radical cystectomy with downstaging and upstaging occurring in 27% and 49% of patients, respectively. Downstaged patients had better overall (P = 0.003) and bladder cancer-specific (P = 0.0004) survivals. None of the downstaged patient died from bladder cancer (median follow-up 35.9 months). Upstaged patients were five times as likely to succumb from bladder cancer or other illness compared to downstaged patients. This effect was not isolated to patients with lower clinical stages but also demonstrated in patients with clinical stage T2 bladder cancer.
  
  
  CONCLUSIONS
  Stage divergence is common after radical cystectomy occurring in 76% of patients in this study. The implications of stage divergence are equally relevant for those who are upstaged or downstaged in terms of survival, and such data is useful when counseling patients postoperatively. Downstaging at the time of radical cystectomy is associated with better overall and cancer-specific survival.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA. bhollen@umich.edu
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*