title: Comparison of American Joint Committee on Cancer pathologic stage T3a versus T3b urothelial carcinoma: analysis of patient outcomes.
abstract: BACKGROUND
  The radical cystectomy experience at Vanderbilt University Medical Center was scrutinized to determine whether there was a difference in survival between patients with lymph node-negative pathologic T3a versus pathologic T3b urothelial carcinoma of the bladder.
  
  
  METHODS
  Pathologic and clinical data were reviewed on patients who underwent radical cystectomy for urothelial carcinoma between 1995 and 2005. We excluded patients with nontransitional cell cancer, lymph node disease, or with unknown lymph node status. Of the 790 reviewed patients, 75 patients (9.4%) were diagnosed with pathologic T3 urothelial cancer of the bladder. The impact of pathologic substaging (pT3a vs pT3b) was examined to determine the effect on overall, disease-specific, and recurrence-free survival.
  
  
  RESULTS
  The mean age was 68.6 years (36 years to 83 years). Median overall follow-up was 25.3 months (1.13 months to 130.17 months). Median follow-up for patients alive at last follow-up was 55.9 months (25.3 months to 130.2 months). Actuarial overall survival at 5 years was 29.5% for pT3a and 29.3% for pT3b (P = .79). Actuarial disease-specific survival at 5 years was 54.1% for pT3a and 42.4% for pT3b (P = .21). Actuarial recurrence-free survival at 5 years was 68.1% for pT3a and 71.9% for pT3b (P = .53).
  
  
  CONCLUSIONS
  There were no significant differences in overall, disease-specific, or recurrence-free survival when comparing lymph node-negative pT3a versus pT3b urothelial cancer of the bladder following radical cystectomy. Simplification of pathologic staging for urothelial carcinoma of the bladder should be considered at future revisions of the American Joint Committee on Cancer staging system.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. kelly.boudreaux@vanderbilt.edu
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Boudreaux
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: William T
authors.initials: WT
authors.lastname: Lowrance
authors.forename: Jon A
authors.initials: JA
authors.lastname: Rumohr
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging / Q000592:standards*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery