期刊
BJU INTERNATIONAL
卷 113, 期 6, 页码 894-899出版社
WILEY
DOI: 10.1111/bju.12245
关键词
urinary bladder neoplasms; outcome and process assessment (health care); urinary bladder; cystectomy; surgical pathology
资金
- National Institutes of Health, an Agency for Healthcare Research and Quality [CA-90625, 1R01HS019356]
- National Center for Research Resources
- National Center for Advancing Translational Sciences, National Institutes of Health [UL1 RR025744, UL1 RR024975]
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. Patients and 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.
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