1898 COMPARISON OF THE AMERICAN JOINT COMMITTEE ON CANCER SUBSTRATIFICATION IN LYMPH-NODE NEGATIVE PT3 BLADDER CANCER: ANALYSIS OF PATIENT OUTCOMES IN A CONTEMPORARY SERIES
2012-04-01

You have accessJournal of UrologyBladder Cancer: Metastatic Disease/Staging1 Apr 20121898 COMPARISON OF THE AMERICAN JOINT COMMITTEE ON CANCER SUBSTRATIFICATION IN LYMPH-NODE NEGATIVE PT3 BLADDER CANCER: ANALYSIS OF PATIENT OUTCOMES IN A CONTEMPORARY SERIES Mohamed F. Abdelhafez, Tilman Todenhöfer, Markus Renninger, Arnulf Stenzl, and Georgios Gakis Mohamed F. AbdelhafezMohamed F. Abdelhafez Tuebingen, Germany More articles by this author , Tilman TodenhöferTilman Todenhöfer Tuebingen, Germany More articles by this author , Markus RenningerMarkus Renninger Tuebingen, Germany More articles by this author , Arnulf StenzlArnulf Stenzl Tuebingen, Germany More articles by this author , and Georgios GakisGeorgios Gakis Tuebingen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2054AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine whether there is a difference in survival in patients with lymph-node negative pT3a vs. pT3b bladder cancer as some recent single-center studies suggest that the American Joint Committee on Cancer substratification in pT3 disease may not have any prognostic significance. METHODS Of 307 consecutive patients undergoing radical cystectomy with bilateral pelvic lymphadenectomy between 1999 and 2011, 97 (30.9%) had pT3cM0 bladder cancer. Fisher Exact Test and Cox-proportional hazard assumption were used for uni- and multivariate analysis of risk factors. Kaplan Meier plots were used to estimate the impact of pT3 substaging in lymph-node negative disease on recurrence-free (RFS) survival using log-rank test. Median follow-up was 27 months (6-116) in the total cohort. RESULTS Of the 97 patients with pT3cM0, 52 had node-negative pT3 (53.6%) and 45 (46.4%) node-positive pT3 stage on definitive histological examination. Median number of retrieved lymph nodes was 17 (3-36) in pT3a and 20 (3-53) in pT3b patients (p=0.10). Median number of retrieved LN was 18 (3-36) in node-negative and 19 (3-53) in node-positive patients (p=0.58). In all 97 patients, pT3 substaging was only associated with resection margin status (p=0.047). In univariate analysis, no further associations were found for age, gender, lymph node tumor involvement, postoperative chemotherapy, hydronephrosis, non-pure urothelial carcinoma pathology and lymphovascular invasion. None of the 52 patients with pT3N0 disease had positive resection margins. The 3-/5-year RFS was 66.0/55.0% in patients with pT3aN0 and 29.6/14.8% in those with pT3bN0 bladder cancer (p=0.035). In multivariate analysis, pT3 substaging was the only independent risk factor of recurrence in node-negative patients (p=0.037). CONCLUSIONS In this contemporary single-center series, there was a significant difference in RFS between patients with lymph-node negative pT3a vs. pT3b bladder cancer, and pT3 substaging was an independent risk factor for recurrence. These data are supportive of the current concept of substratification in lymph-node negative pT3 bladder cancer. Thus, pT3 substaging may be helpful in selecting patients who might benefit from adjuvant trials. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187 Issue 4S April 2012 Page: e765-e766 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Mohamed F. Abdelhafez Tuebingen, Germany More articles by this author Tilman Todenhöfer Tuebingen, Germany More articles by this author Markus Renninger Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Georgios Gakis Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...