Does the gross prosector impact pT3 subclassification or lymph node counts in bladder cancer?

Tretter, Eric M.; Ebel, Joshua; Pohar, Kamal S.; Zynger, Debra L.

doi:10.1016/j.humpath.2016.12.009

Cited by 10 publications

(4 citation statements)

References 28 publications

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“…Although gross diagnosis of macroscopic perivesical soft tissue invasion is a critical component of the AJCC Staging Manual 8th edition and appears to have prognostic implications in a subset of pT3 patients, it is not always straightforward and hinges heavily on the thoroughness and accuracy of the prosector . Unfortunately, assessment of extravesical extension of the tumour is not always documented in the prosector's gross description, and a recent study from a large tertiary care academic institution found that this was missing in 17% of reports . Most of these cases were staged as pT3a, and it is plausible that failure to document macroscopic extension resulted in understaging these tumours.…”

Section: Stage Pt3 Carcinomamentioning

confidence: 99%

“…2 Unfortunately, assessment of extravesical extension of the tumour is not always documented in the prosector's gross description, and a recent study from a large tertiary care academic institution found that this was missing in 17% of reports. 121 Most of these cases were staged as pT3a, and it is plausible that failure to document macroscopic extension resulted in understaging these tumours. Importantly, the authors also found that educational intervention increased the rate of reporting presence or absence of extravesical extension.…”

Section: Stage Pt3 Carcinomamentioning

confidence: 99%

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Staging of bladder cancer

et al. 2018

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Urothelial carcinoma of the urinary bladder is a heterogeneous disease with multiple possible treatment modalities and a wide spectrum of clinical outcome. Treatment decisions and prognostic expectations hinge on accurate and precise staging, and the recently published American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition, should be the basis for staging of urinary bladder tumours. It is unfortunate that the International Union Against Cancer (UICC) 8th edition failed to incorporate new data which is considered in the AJCC 8th edition. Thus, the AJCC 8th edition is the focus of this review. Several critical changes and clarifications are made by the AJCC 8th edition relative to the 7th edition. Although the most obvious changes in the 8th edition are in the N (i.e. perivesical lymph node involvement now classified as N1) and M (i.e. M1 is subdivided into M1a and M1b) categories, several points are clarified in the T category (e.g. substaging of pT1 should be attempted). Further optimisation, however, is required. No particular method of substaging pT1 is formally recommended. In this review, these modifications are discussed, as well as points, which require further study and optimisation.

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Section: Stage Pt3 Carcinomamentioning

confidence: 99%

Section: Stage Pt3 Carcinomamentioning

confidence: 99%

Staging of bladder cancer

et al. 2018

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“…Additionally, the lack of long-term clinical data limits our analysis of the downstream benefits or harms of PLND in a low-risk PCa population. Furthermore, it is well known that the specific methods of pathological analysis of lymph node tissue can impact the number of lymph nodes detected and investigated 19, 20 . With this data, we are unable to account for differential processing and pathological analysis of lymph node tissue.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Pelvic Lymph Node Dissection for Patients With Low-Risk Prostate Cancer Treated With Robot-Assisted Radical Prostatectomy

Modi

Bock

Kim

et al. 2017

Clinical Genitourinary Cancer

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Introduction Pelvic lymph node dissection (PLND) is not recommended for low-risk prostate cancer (PCa) patients. However, the rate of PLND in this population is unknown. Methods We queried the National Cancer Database for PCa patients who underwent RARP from 2010 to 2013 and stratified them by D′Amico risk classification. We identified the frequency of PLND in low-risk patients and identified factors associated with receipt of PLND. Further, we determined the number of lymph nodes evaluated (quality) and proportion of patients with detected nodal metastatic disease (utility) in each risk group. Results Of 51,971 patients with low-risk PCa who underwent RARP, 19,059 (36.7%) received PLND. Predictors of PLND in low-risk patients included rural residence (OR 1.157, 95%CI 1.009-1.327), treatment at an academic center (OR 1.492, 95%CI 1.188-1.874), and high-volume facility (OR 1.327, 95%CI 1.078-1.633). The mean number of lymph nodes obtained in low-risk patients was lower than in intermediate/high-risk patients (4.74 vs 5.86, P<0.0001). Lymph node positivity was identified in 0.4% of low-risk patients and 4.6% of intermediate/high-risk patients. Conclusions While PLND is not recommended for low-risk PCa by clinical practice guidelines, it was performed frequently (36.7%) in a large hospital-based data set. PLND in this population was of lower quality (nodal yield) and had less utility of detecting nodal metastatic disease than PLND in intermediate and high-risk PCa. Treatment at a high-volume or academic center was associated with increased use of PLND. Reasons for the variation in practice patterns should be investigated to improve the value of PCa care.

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“…T3 substaging, on the other hand, has been in use for many years, and its impact has only rarely been questioned. Here, Tretter et al demonstrate that 17% of radical cystectomy grossing reports lacked statements on perivesicular adipose invasion, of which 75% were classified as pT3a [6]. An earlier study of Zarei et al went even further, reporting no difference in cancer specific survival (CSS) between pT2N0 and pT3N0, or pT3aN0 and pT3bN0 stages [7].…”

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confidence: 93%

Latest Developments and Current Problems in Bladder Cancer

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2021

World J Urol

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Does the gross prosector impact pT3 subclassification or lymph node counts in bladder cancer?

Cited by 10 publications

References 28 publications

Staging of bladder cancer

Staging of bladder cancer

Utilization of Pelvic Lymph Node Dissection for Patients With Low-Risk Prostate Cancer Treated With Robot-Assisted Radical Prostatectomy

Latest Developments and Current Problems in Bladder Cancer

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