Residual Pathological Stage at Radical Cystectomy Significantly Impacts Outcomes for Initial T2N0 Bladder Cancer

Hendrik Isbarn, Pierre I. Karakiewicz, Shahrokh F. Shariat, Umberto Capitanio, Ganesh S. Palapattu, Arthur I. Sagalowsky, Yair Lotan, Mark P. Schoenberg, Gilad E. Amiel, Seth P. Lerner, Guru Sonpavde

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: We hypothesized that in patients with T2N0 stage disease at transurethral bladder tumor resection a lower residual cancer stage (P1N0 or less) at radical cystectomy may correlate with improved outcomes relative to those with residual P2N0 disease. Materials and Methods: We analyzed 208 patients with T2N0 stage disease at transurethral bladder tumor resection whose tumors were organ confined at radical cystectomy (P2 or lower, pN0). None received perioperative chemotherapy. Kaplan-Meier as well as univariable and multivariable Cox regression models addressed the effect of residual pT stage at radical cystectomy on recurrence and cancer specific mortality rates. Covariates consisted of age, gender, grade, lymphovascular invasion, carcinoma in situ, number of lymph nodes removed and year of surgery. Results: Residual pT stage at radical cystectomy was P0 in 24 (11.5%) patients, Pa in 9 (4.3%), PCIS in 22 (10.6%), P1 in 35 (16.8%) and P2 in 118 (56.7%). Median followup of censored patients was 55.7 months for recurrence and 52.1 months for cancer specific mortality analyses. The 5-year recurrence-free survival rates of patients with P0/Pa/PCIS, P1 and P2 stage disease were 100%, 85% and 75%, respectively. The 5-year cancer specific survival rates for the same cohorts were 100%, 93% and 81%, respectively. On multivariable analysis the effect of residual stage P1 or lower at radical cystectomy achieved independent predictor status for recurrence (adjusted HR 0.20, p = 0.002) and cancer specific mortality (adjusted HR 0.24, p = 0.02). Conclusions: Down staging from initial T2N0 bladder cancer at transurethral bladder tumor resection to lower stage at radical cystectomy significantly reduces recurrence and cancer specific mortality. Further validation of this finding is warranted.

Original languageEnglish (US)
Pages (from-to)459-465
Number of pages7
JournalJournal of Urology
Volume182
Issue number2
DOIs
StatePublished - Aug 2009
Externally publishedYes

Fingerprint

Cystectomy
Urinary Bladder Neoplasms
Recurrence
Neoplasms
Mortality
Survival Rate
Carcinoma in Situ
Residual Neoplasm
Proportional Hazards Models
Lymph Nodes
Drug Therapy

Keywords

  • carcinoma, transitional cell
  • cystectomy, urinary bladder neoplasms, neoplasm staging

ASJC Scopus subject areas

  • Urology

Cite this

Isbarn, H., Karakiewicz, P. I., Shariat, S. F., Capitanio, U., Palapattu, G. S., Sagalowsky, A. I., ... Sonpavde, G. (2009). Residual Pathological Stage at Radical Cystectomy Significantly Impacts Outcomes for Initial T2N0 Bladder Cancer. Journal of Urology, 182(2), 459-465. https://doi.org/10.1016/j.juro.2009.04.017

Residual Pathological Stage at Radical Cystectomy Significantly Impacts Outcomes for Initial T2N0 Bladder Cancer. / Isbarn, Hendrik; Karakiewicz, Pierre I.; Shariat, Shahrokh F.; Capitanio, Umberto; Palapattu, Ganesh S.; Sagalowsky, Arthur I.; Lotan, Yair; Schoenberg, Mark P.; Amiel, Gilad E.; Lerner, Seth P.; Sonpavde, Guru.

In: Journal of Urology, Vol. 182, No. 2, 08.2009, p. 459-465.

Research output: Contribution to journalArticle

Isbarn, H, Karakiewicz, PI, Shariat, SF, Capitanio, U, Palapattu, GS, Sagalowsky, AI, Lotan, Y, Schoenberg, MP, Amiel, GE, Lerner, SP & Sonpavde, G 2009, 'Residual Pathological Stage at Radical Cystectomy Significantly Impacts Outcomes for Initial T2N0 Bladder Cancer', Journal of Urology, vol. 182, no. 2, pp. 459-465. https://doi.org/10.1016/j.juro.2009.04.017
Isbarn H, Karakiewicz PI, Shariat SF, Capitanio U, Palapattu GS, Sagalowsky AI et al. Residual Pathological Stage at Radical Cystectomy Significantly Impacts Outcomes for Initial T2N0 Bladder Cancer. Journal of Urology. 2009 Aug;182(2):459-465. https://doi.org/10.1016/j.juro.2009.04.017
Isbarn, Hendrik ; Karakiewicz, Pierre I. ; Shariat, Shahrokh F. ; Capitanio, Umberto ; Palapattu, Ganesh S. ; Sagalowsky, Arthur I. ; Lotan, Yair ; Schoenberg, Mark P. ; Amiel, Gilad E. ; Lerner, Seth P. ; Sonpavde, Guru. / Residual Pathological Stage at Radical Cystectomy Significantly Impacts Outcomes for Initial T2N0 Bladder Cancer. In: Journal of Urology. 2009 ; Vol. 182, No. 2. pp. 459-465.
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abstract = "Purpose: We hypothesized that in patients with T2N0 stage disease at transurethral bladder tumor resection a lower residual cancer stage (P1N0 or less) at radical cystectomy may correlate with improved outcomes relative to those with residual P2N0 disease. Materials and Methods: We analyzed 208 patients with T2N0 stage disease at transurethral bladder tumor resection whose tumors were organ confined at radical cystectomy (P2 or lower, pN0). None received perioperative chemotherapy. Kaplan-Meier as well as univariable and multivariable Cox regression models addressed the effect of residual pT stage at radical cystectomy on recurrence and cancer specific mortality rates. Covariates consisted of age, gender, grade, lymphovascular invasion, carcinoma in situ, number of lymph nodes removed and year of surgery. Results: Residual pT stage at radical cystectomy was P0 in 24 (11.5{\%}) patients, Pa in 9 (4.3{\%}), PCIS in 22 (10.6{\%}), P1 in 35 (16.8{\%}) and P2 in 118 (56.7{\%}). Median followup of censored patients was 55.7 months for recurrence and 52.1 months for cancer specific mortality analyses. The 5-year recurrence-free survival rates of patients with P0/Pa/PCIS, P1 and P2 stage disease were 100{\%}, 85{\%} and 75{\%}, respectively. The 5-year cancer specific survival rates for the same cohorts were 100{\%}, 93{\%} and 81{\%}, respectively. On multivariable analysis the effect of residual stage P1 or lower at radical cystectomy achieved independent predictor status for recurrence (adjusted HR 0.20, p = 0.002) and cancer specific mortality (adjusted HR 0.24, p = 0.02). Conclusions: Down staging from initial T2N0 bladder cancer at transurethral bladder tumor resection to lower stage at radical cystectomy significantly reduces recurrence and cancer specific mortality. Further validation of this finding is warranted.",
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AU - Capitanio, Umberto

AU - Palapattu, Ganesh S.

AU - Sagalowsky, Arthur I.

AU - Lotan, Yair

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