Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy.
OBJECTIVE
To evaluate predictors of understaging in patients with presumed non-muscle-invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumour (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT.


METHODS
We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease after TURBT who underwent RC at our institution from April 2000 to July 2011. In all, 60 of these cT1 patients had undergone a restaging TURBT before RC. The primary outcome measure was pathological staging of ≥T2 disease at the time of RC.


RESULTS
In all, 134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumour (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.25-0.76, P = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71-1.00, P = 0.05) were independent risk factors for understaging.


CONCLUSIONS
Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumour and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC.
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Jacob T
JT
Ark
Kirk A
KA
Keegan
Daniel A
DA
Barocas
Todd M
TM
Morgan
Matthew J
MJ
Resnick
Chaochen
C
You
Michael S
MS
Cookson
David F
DF
Penson
Rodney
R
Davis
Peter E
PE
Clark
Joseph A
JA
Smith
Sam S
SS
Chang
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D006801:Humans; D009367:Neoplasm Staging / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery
cystectomy; outcome and process assessment (health care); surgical pathology; urinary bladder; urinary bladder neoplasms