Introduction:
To identify predictors and survival outcomes of pathological upstaging after radical cystectomy (RC) in patients with non-muscle-invasive bladder cancer (NMIBC).
Methods:
We investigated the National Cancer Database (NCDB) for patients who underwent RC for NMIBC between 2004 and 2015. Patients were then stratified according to pathological upstaging at RC. Multivariate logistic regression models were fitted to identify independent predictors of undergoing RC and pathological upstaging. Overall survival (OS) was evaluated in upstaged vs. non-upstaged patients, as well as in patients with organ-confined vs. non-organ-confined upstaging.
Results:
We identified 8,620 patients with NMIBC who underwent RC, of which 3,100 (36%) patients were upstaged. Among upstaged patients; 1,335 (43%) had organ-confined (<pT3) disease. Multivariate analysis identified predictors of RC to be younger age (≥80 vs. <60; OR 0.24), male gender (OR 1.22), treatment at academic centers (OR 7.17), presence of lymphovascular invasion (LVI) (OR 4.0), and histologic variant (pure urothelial vs. variant; OR 0.4; p<0.001 for all). Similarly, predictors of upstaging included high-grade (OR 1.38, p<0.001), advancing age (≥80 vs. <60, OR 1.57, p=0.003), sarcomatoid and squamous histologies (vs. urothelial, OR 1.39, p=0.016; and OR 6.39, p<0.001; respectively), and LVI (OR 7.7, p<0.001).
5yOS was 71% in non-upstaged patients vs. 39.9% in upstaged (HR 2.92, p<0.001). Other predictors of survival included older age (≥80 vs. <60, HR 2.62, p<0.001), neuroendocrine or sarcomatoid variants (HR 2 and 2.6, respectively, p<0.001), and positive surgical margin (HR 1.7, p<0.001).
Conclusion:
On a nationwide level, predictable adverse pathological features are associated with pathological upstaging. Such upstaging is associated with significantly poor OS particularly in patients with the non-organ confined disease. These adverse pathological features should be considered when counseling patients regarding early radical cystectomy.
Funding: N/A
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PREDICTORS AND OUTCOMES OF PATHOLOGICAL UPSTAGING IN PATIENTS WITH NON-MUSCLE-INVASIVE BLADDER CANCER FOLLOWING RADICAL CYSTECTOMY
Category
Bladder Cancer > Non-Muscle Invasive Bladder Cancer
Description
Poster #5
Wednesday, Dec 1
1:00 p.m. - 2:00 p.m.
Bladder 1
Presented By: Furkan Dursun
Authors:
Ahmed Elshabrawy
Furkan Dursun
Hanzhang Wang
Dharam Kaushik
Michael A. Liss
Robert S. Svatek
Ahmed M. Mansour