Outcomes of Patients with Clinical T1 Grade 3 Urothelial Cell Bladder Carcinoma Treated with Radical Cystectomy

Amit Gupta, Yair Lotan, Patrick J. Bastian, Ganesh S. Palapattu, Pierre I. Karakiewicz, Ganesh V. Raj, Mark P. Schoenberg, Seth P. Lerner, Arthur I. Sagalowsky, Shahrokh F. Shariat

Research output: Contribution to journalArticle

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Abstract

Objectives: Urothelial tumors that invade the lamina propria but not the muscularis propria are a particularly problematic clinical entity. The aim of the present study was to assess the pathologic features and clinical outcomes of patients with clinical T1 grade 3 urothelial cell bladder carcinoma (UCBC) treated with radical cystectomy. Methods: We reviewed the records of 958 consecutive patients who underwent radical cystectomy and pelvic lymphadenectomy for bladder cancer at three U.S. academic centers. Of these patients, 167 (median age, 66.7 years) underwent radical cystectomy for clinical stage T1 grade 3 UCBC. Results: The median follow-up was 33.8 months (mean ± standard deviation: 45.9 ± 39.2 months, range, 0.4 to 177.1) for patients alive at last follow-up. Disease recurred in 48 of 167 of patients (29.4%) and 30 of 162 patients (18.5%) died from bladder cancer. A total of 29 of 166 patients (17.5%) had lymph nodal metastases. Of 167 patients, 84 (50%) were pathologically upstaged and 167 (27.5%) had extravesical disease. Patients with disease upstaging had poorer survival (P <0.001). A greater than 3-month delay between cystectomy and last transurethral resection showed a trend toward upstaging (P = 0.06). Presence of carcinoma in situ (CIS) was the only precystecomy factor that predicted disease recurrence (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.14 to 3.98) and mortality (HR: 2.75, 95% CI: 1.17 to 6.46). Conclusions: A large proportion of patients undergoing cystectomy for clinical T1 grade 3 disease have adverse pathological features. The recurrence and survival outcomes in this group are suboptimal. Presence of CIS precystectomy predicts outcomes. Better markers are needed to identify patients at high risk for adverse outcomes.

Original languageEnglish (US)
Pages (from-to)302-307
Number of pages6
JournalUrology
Volume71
Issue number2
DOIs
StatePublished - Feb 2008
Externally publishedYes

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Cystectomy
Urinary Bladder
Carcinoma
Carcinoma in Situ
Urinary Bladder Neoplasms
3-monoiodothyronine
Confidence Intervals
Recurrence
Survival
Lymph
Lymph Node Excision
Mucous Membrane
Neoplasm Metastasis

ASJC Scopus subject areas

  • Urology

Cite this

Gupta, A., Lotan, Y., Bastian, P. J., Palapattu, G. S., Karakiewicz, P. I., Raj, G. V., ... Shariat, S. F. (2008). Outcomes of Patients with Clinical T1 Grade 3 Urothelial Cell Bladder Carcinoma Treated with Radical Cystectomy. Urology, 71(2), 302-307. https://doi.org/10.1016/j.urology.2007.10.041

Outcomes of Patients with Clinical T1 Grade 3 Urothelial Cell Bladder Carcinoma Treated with Radical Cystectomy. / Gupta, Amit; Lotan, Yair; Bastian, Patrick J.; Palapattu, Ganesh S.; Karakiewicz, Pierre I.; Raj, Ganesh V.; Schoenberg, Mark P.; Lerner, Seth P.; Sagalowsky, Arthur I.; Shariat, Shahrokh F.

In: Urology, Vol. 71, No. 2, 02.2008, p. 302-307.

Research output: Contribution to journalArticle

Gupta, A, Lotan, Y, Bastian, PJ, Palapattu, GS, Karakiewicz, PI, Raj, GV, Schoenberg, MP, Lerner, SP, Sagalowsky, AI & Shariat, SF 2008, 'Outcomes of Patients with Clinical T1 Grade 3 Urothelial Cell Bladder Carcinoma Treated with Radical Cystectomy', Urology, vol. 71, no. 2, pp. 302-307. https://doi.org/10.1016/j.urology.2007.10.041
Gupta, Amit ; Lotan, Yair ; Bastian, Patrick J. ; Palapattu, Ganesh S. ; Karakiewicz, Pierre I. ; Raj, Ganesh V. ; Schoenberg, Mark P. ; Lerner, Seth P. ; Sagalowsky, Arthur I. ; Shariat, Shahrokh F. / Outcomes of Patients with Clinical T1 Grade 3 Urothelial Cell Bladder Carcinoma Treated with Radical Cystectomy. In: Urology. 2008 ; Vol. 71, No. 2. pp. 302-307.
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abstract = "Objectives: Urothelial tumors that invade the lamina propria but not the muscularis propria are a particularly problematic clinical entity. The aim of the present study was to assess the pathologic features and clinical outcomes of patients with clinical T1 grade 3 urothelial cell bladder carcinoma (UCBC) treated with radical cystectomy. Methods: We reviewed the records of 958 consecutive patients who underwent radical cystectomy and pelvic lymphadenectomy for bladder cancer at three U.S. academic centers. Of these patients, 167 (median age, 66.7 years) underwent radical cystectomy for clinical stage T1 grade 3 UCBC. Results: The median follow-up was 33.8 months (mean ± standard deviation: 45.9 ± 39.2 months, range, 0.4 to 177.1) for patients alive at last follow-up. Disease recurred in 48 of 167 of patients (29.4{\%}) and 30 of 162 patients (18.5{\%}) died from bladder cancer. A total of 29 of 166 patients (17.5{\%}) had lymph nodal metastases. Of 167 patients, 84 (50{\%}) were pathologically upstaged and 167 (27.5{\%}) had extravesical disease. Patients with disease upstaging had poorer survival (P <0.001). A greater than 3-month delay between cystectomy and last transurethral resection showed a trend toward upstaging (P = 0.06). Presence of carcinoma in situ (CIS) was the only precystecomy factor that predicted disease recurrence (hazard ratio [HR]: 2.13, 95{\%} confidence interval [CI]: 1.14 to 3.98) and mortality (HR: 2.75, 95{\%} CI: 1.17 to 6.46). Conclusions: A large proportion of patients undergoing cystectomy for clinical T1 grade 3 disease have adverse pathological features. The recurrence and survival outcomes in this group are suboptimal. Presence of CIS precystectomy predicts outcomes. Better markers are needed to identify patients at high risk for adverse outcomes.",
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AU - Gupta, Amit

AU - Lotan, Yair

AU - Bastian, Patrick J.

AU - Palapattu, Ganesh S.

AU - Karakiewicz, Pierre I.

AU - Raj, Ganesh V.

AU - Schoenberg, Mark P.

AU - Lerner, Seth P.

AU - Sagalowsky, Arthur I.

AU - Shariat, Shahrokh F.

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N2 - Objectives: Urothelial tumors that invade the lamina propria but not the muscularis propria are a particularly problematic clinical entity. The aim of the present study was to assess the pathologic features and clinical outcomes of patients with clinical T1 grade 3 urothelial cell bladder carcinoma (UCBC) treated with radical cystectomy. Methods: We reviewed the records of 958 consecutive patients who underwent radical cystectomy and pelvic lymphadenectomy for bladder cancer at three U.S. academic centers. Of these patients, 167 (median age, 66.7 years) underwent radical cystectomy for clinical stage T1 grade 3 UCBC. Results: The median follow-up was 33.8 months (mean ± standard deviation: 45.9 ± 39.2 months, range, 0.4 to 177.1) for patients alive at last follow-up. Disease recurred in 48 of 167 of patients (29.4%) and 30 of 162 patients (18.5%) died from bladder cancer. A total of 29 of 166 patients (17.5%) had lymph nodal metastases. Of 167 patients, 84 (50%) were pathologically upstaged and 167 (27.5%) had extravesical disease. Patients with disease upstaging had poorer survival (P <0.001). A greater than 3-month delay between cystectomy and last transurethral resection showed a trend toward upstaging (P = 0.06). Presence of carcinoma in situ (CIS) was the only precystecomy factor that predicted disease recurrence (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.14 to 3.98) and mortality (HR: 2.75, 95% CI: 1.17 to 6.46). Conclusions: A large proportion of patients undergoing cystectomy for clinical T1 grade 3 disease have adverse pathological features. The recurrence and survival outcomes in this group are suboptimal. Presence of CIS precystectomy predicts outcomes. Better markers are needed to identify patients at high risk for adverse outcomes.

AB - Objectives: Urothelial tumors that invade the lamina propria but not the muscularis propria are a particularly problematic clinical entity. The aim of the present study was to assess the pathologic features and clinical outcomes of patients with clinical T1 grade 3 urothelial cell bladder carcinoma (UCBC) treated with radical cystectomy. Methods: We reviewed the records of 958 consecutive patients who underwent radical cystectomy and pelvic lymphadenectomy for bladder cancer at three U.S. academic centers. Of these patients, 167 (median age, 66.7 years) underwent radical cystectomy for clinical stage T1 grade 3 UCBC. Results: The median follow-up was 33.8 months (mean ± standard deviation: 45.9 ± 39.2 months, range, 0.4 to 177.1) for patients alive at last follow-up. Disease recurred in 48 of 167 of patients (29.4%) and 30 of 162 patients (18.5%) died from bladder cancer. A total of 29 of 166 patients (17.5%) had lymph nodal metastases. Of 167 patients, 84 (50%) were pathologically upstaged and 167 (27.5%) had extravesical disease. Patients with disease upstaging had poorer survival (P <0.001). A greater than 3-month delay between cystectomy and last transurethral resection showed a trend toward upstaging (P = 0.06). Presence of carcinoma in situ (CIS) was the only precystecomy factor that predicted disease recurrence (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.14 to 3.98) and mortality (HR: 2.75, 95% CI: 1.17 to 6.46). Conclusions: A large proportion of patients undergoing cystectomy for clinical T1 grade 3 disease have adverse pathological features. The recurrence and survival outcomes in this group are suboptimal. Presence of CIS precystectomy predicts outcomes. Better markers are needed to identify patients at high risk for adverse outcomes.

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