title: pT3 Substaging is a prognostic indicator for lymph node negative urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  We assessed the prognostic value of pT3 bladder urothelial carcinoma substaging.
  
  
  METHODS
  We reviewed the records of 2,605 patients treated with radical cystectomy for bladder urothelial carcinoma at 6 international centers, of whom 808 (31.0%) had pT3 disease. No patient received systemic chemotherapy or radiotherapy preoperatively. Median followup was 45 months in survivors at last followup.
  
  
  RESULTS
  Median patient age was 68 years. Stage was pT3a in 310 patients (38.4%) and pT3b in 498 (61.6%). Of the patients 352 (43.6%) had metastasis to regional lymph nodes. Five-year recurrence-free (43.8% and 41.4%) and cancer specific (48.6% and 46.8%) survival estimates were similar in pT3a and pT3b cases (p = 0.277 and 0.625, respectively). Conversely in patients with pathologically negative lymph nodes pT3b substaging was associated with worse 5-year recurrence-free (60.7% vs 47.9%) and cancer specific (64.4% vs 55.0%) survival (p = 0.020 vs 0.048).
  
  
  CONCLUSIONS
  Macroscopic perivesical fat extension (pT3b) is associated with a worse outcome than pT3a disease in lymph node negative cases of bladder urothelial carcinoma. Together with other features pT3 substaging may help identify patients with pT3 who could benefit from adjuvant chemotherapy.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Michael
authors.initials: M
authors.lastname: Seitz
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Eila
authors.initials: E
authors.lastname: Skinner
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery