Discrepancy between clinical staging through bimanual palpation and pathological staging after cystectomy

Ploeg, Matthias; Kiemeney, Lambertus A.; Smits, G.A.H.J.; Vergunst, H.; Viddeleer, André C.; Geboers, A. D. H.; Berkel, H.; Boven, E.; Aben, Katja K.H.; Witjes, J. Alfred

doi:10.1016/j.urolonc.2009.12.020

Cited by 38 publications

(16 citation statements)

References 11 publications

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“…For all bladder cancer patients, the rate of upstaging cited in the literature is 31% to 50%. 9,10 These figures, at a minimum, underscore the need for improved staging techniques, particularly in this subset of patients with high-risk disease.…”

Section: Discussionmentioning

confidence: 99%

Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort

Power

Kassouf

Bell

et al. 2012

CUAJ

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Background: The present study documents the natural history and outcomes of high-risk bladder cancer after radical cystectomy (RC) in patients who did not receive neoadjuvant chemotherapy during a contemporary time period. Methods: We analyzed 1180 patients from 1993 to 2008 with >pT3N0 or pT0-4N+ bladder cancer who underwent RC ± standard (sLND) or extended (eLND) lymph node dissection from 8 Canadian centres. Results: Of the 1180 patients, 55% (n = 643) underwent sLND, 34% (n = 402) underwent ePLND and 11% did not undergo a formal LND. Of the total number of patients, 321 (27%) received adjuvant chemotherapy. The median follow-up was 2.1 years (range: 0.6 to 12.9). Overall 30-day mortality was 3.2%. Clinical and pathological stages T3-4 were present in 6.1% and 86.7% of the patients, respectively; this demonstrates a dramatic understaging. Overall survival (OS) at 2 and 5 years was 60% and 43%, respectively. Patients who received adjuvant chemotherapy had a 2-and 5-year disease-specific survival (DSS) of 72% and 57% versus 64% and 51% for those who did not (log-rank p = 0.0039). The 2-and 5-year OS for high-risk node-negative disease was 67% and 52%, respectively, whereas for node-positive patients, the OS was 52% and 32%, respectively (p < 0.001). The OS, DSS and RFS for patients with pN0 were significantly improved compared to those who did not undergo a LND (log-rank p = 0.0035, 0.0241 and 0.0383, respectively). Interpretation: This series suggests that bladder cancer outcomes in advanced disease have improved in the modern era. The need for improved staging investigations, use of neoadjuvant chemotherapy and performance of complete LND is emphasized.

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Section: Discussionmentioning

confidence: 99%

Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort

Power

Kassouf

Bell

et al. 2012

CUAJ

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“…It is well established that preoperative staging is inaccurate in approximately 50 % of patients undergoing RC [14][15][16]. The NCCN guidelines recommend imaging with either contrast-enhanced CT scanning or MR Urography [11]; however, the sensitivity of these studies ranges from 60.0 to 76.4 % [17,18].…”

Section: Discussionmentioning

confidence: 99%

The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy

Parker

Boorjian

et al. 2016

World J Urol

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Patients without evidence of disease at the time of RC are still at risk of recurrence and death from bladder cancer. Higher clinical stage and increased time to RC were associated with an increased risk of recurrence and subsequent death. These data highlight the importance of timely RC and the continued risk of recurrence in higher clinically staged patients-underscoring the need for close monitoring and patient counseling.

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“…However, more clinically significant endpoints are predicting disease outcome or response to therapy and it will be the focus of future studies. Additionally, the study did not include other possible risk factors for advanced disease, such as biomarkers, 7 bimanual palpations 26 . These data were not available in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, lack of sufficient data on bimanual palpation could indicate that most current urologists are relying more and more on these pelvic imaging techniques during the clinical staging process and in accordance with the observed decrease in the number of bimanual palpation performed in the last decades. Furthermore, bimanual palpation is a subjective measure, and depends on both the experience of the surgeon and the physical constitution of the patient 26 . Our models are not applicable to patients who were pretreated with radiotherapy or to those harboring pathologies other than transitional cell carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Scoring system development for prediction of extravesical bladder cancer

et al. 2014

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Discrepancy between clinical staging through bimanual palpation and pathological staging after cystectomy

Cited by 38 publications

References 11 publications

Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort

Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort

The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy

Scoring system development for prediction of extravesical bladder cancer

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