Incidence and Predictors of Understaging in Patients with Clinical T1 Urothelial Carcinoma Undergoing Radical Cystectomy
Ark JT, Keegan KA, Barocas DA, Morgan TM, Resnick MJ, You C, Cookson MS, Penson DF, Davis R, Clark PE, Smith JA Jr, Chang SS. BJU Int. 2013 May 23. doi: 10.1111/bju.12245. [Epub ahead of print]

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Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, US.


OBJECTIVE: To evaluate predictors of understaging in patients with presumed non-muscle invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumor (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT.

MATERIALS AND METHODS: We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease following TURBT who underwent RC at our institution from April 2000 to July 2011. 60 of these cT1 patients had undergone a restaging TURBT prior to RC. The primary outcome measure was pathological staging of T2 or greater disease at the time of RC.

RESULTS: 134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumor (OR 0.43, 95% CI 0.25-0.76, p = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71 - 1.00, p = 0.05) were independent risk factors for understaging.

CONCLUSIONS: Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumor and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification