The value of pathologic factors in predicting cancer-specific survival among patients treated with radical cystectomy for transitional cell carcinoma of the bladder and prostate

Abstract

Background. A recent consensus conference on bladder carcinoma highlighted the need for pathologic predictors of outcome for patients with transitional cell carcinoma of the bladder. This review was undertaken to determine the pathologic features predictive of cancer‐specific survival after a radical cystectomy and urinary diversion for transitional cell carcinoma of the bladder and prostate. Methods. Between 1969 and 1990, 531 patients with transitional cell carcinoma of the bladder and prostate were treated with radical cystectomy at the Duke University Medical Center. Records and pathologic specimens were analyzed and correlated with outcome. Both univariate and multivariate analyses of the pathologic staging were performed to identify variables predictive of cancer‐specific survival. Results. Univariate analysis indicated that pathologic tumor (pT) stage, positive nodes, positive surgical margins, prostatic stromal involvement, grade, age, ureteral involvement, squamous cell carcinoma, and squamous cell differentiation in the specimen all were predictive of poor cancer‐specific survival. Carcinoma in situ (CIS) in the specimen was not an adverse prognostic indicator. Multivariate analysis demonstrated that the pT stage, nodal involvement, positive surgical margins, patient's age at surgery, and loss of histologic differentiation were predictive of poor cancer‐specific survival. CIS was found again not to have a negative influence on cancer‐specific survival. Conclusions. If any of these features are noted in the final pathologic specimen, patients should be considered for some form of additional postoperative treatment such as chemotherapy or radiation therapy in an attempt to improve their chances for cancer‐free survival. These factors will become more important in selecting which patients should be placed in developing adjuvant clinical trials.

Results with radical cystectomy for treating bladder cancer: a ‘reference standard’ for high‐grade, invasive bladder cancer

“…A 3% mortality rate in the present series is comparable with other contemporary series of radical cystectomy [12,15,16]. Furthermore, preoperative therapy (radiation and/or chemotherapy), and the form of urinary diversion used (continent or incontinent) does not apparently alter the mortality rate.…”

“…There was also a significant difference when stratifying patients by their p-stage; patients with lymph nodepositive disease and organ-confined bladder tumours had a significantly better recurrence-free survival than those with extravesical, lymph node-positive tumours. Similar results with lymph node-positive disease after cystectomy have been reported [12,13,15,18,19].Several studies recently suggested that the number of lymph nodes involved with tumour [18][19][20][21][22], and the extent of the lymph node dissection [18,20,21] are important variables for patients undergoing cystectomy for bladder cancer. We recently re-examined 246 patients with lymph node tumour involvement after radical cystectomy (data not presented) [23] to evaluate other prognostic factors in this high-risk group of patients.…”

Does Squamous Differentiation Portend Worse Outcomes in Urothelial Bladder Cancer?

“…Furthermore, on Cox proportional hazards regression, only pathologic staging and LN status were associated with increased risk of disease specific and all-cause mortality. Our findings are consistent with previously reported studies that have shown that SQD does not portend worse survival on multivariate analysis 6,7,11,23 .…”

“…While recent studies have found certain variants such as micropapillary and plasmacytoid to act more aggressively, SQD has been historically described to act similarly to NV histology 5,11,14,15,18,19 . However, much of the SQD literature draws on older cohorts.…”

“…Although SQD was previously shown to be associated with higher pathologic staging and increased risk of local recurrence, when accounting for stage, SQD does not alter overall survival (OS) or disease-specific survival (DSS) 7,8,[11][12][13] . Furthermore, there is evidence suggesting that SQD may be equally sensitive to chemotherapy as non-variant (NV) urothelial bladder cancer 10,12,[14][15][16][17] .…”