Discrepancy between clinical and pathological stage: external validation of the impact on prognosis in an international radical cystectomy cohort

作者：Svatek Robert S; Shariat Shahrokh F; Novara Giacomo; Skinner Eila C; Fradet Yves; Bastian Patrick J; Kamat Ashish M; Kassouf Wassim; Karakiewicz Pierre I; Fritsche Hans Martin; Izawa Jonathan I; Tilki Derya; Ficarra Vincenzo; Volkmer Bjoern G; I**arn Hendrik; Dinney Colin P^*

来源：BJU International, 2011, 107(6): 898-904.

DOI：10.1111/j.1464-410X.2010.09628.x

• bladder cancer
• survival
• radical cystectomy
• stage
• migration
• discrepancy

What's known on the subject? and What does the study add?
Observations from small retrospective studies have indicated that a considerable number of patients undergoing radical cystectomy for bladder cancer experience a stage migration (either upstaging or downstaging) when comparing clinical and pathological staging. In addition, it is unclear if pathological upstaging is an adverse prognostic feature independent of pathological stage.
We report the frequency of upstaging and downstaging using a large, international multicentre cohort of patients undergoing radical cystectomy for bladder cancer without neoadjuvant chemotherapy. Our findings indicate that pathological upstaging is not an independent adverse prognostic feature when considering pathological stage.
OBJECTIVE
center dot To compare the clinical and pathologic stage among a large, multi-institutional series of patients undergoing radical and to determine the effect of stage discrepancy on outcomes.
PATIENTS AND METHODS
center dot Data was collected from nine centers and 3,393 patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy and pelvic lymphadenectomy without neo-adjuvant chemotherapy.
center dot A retrospective cohort design was used to assess the percentage of patients experiencing stage discrepancy and the impact of stage discrepancy on time to disease relapse and time to death from UCB.
RESULTS
center dot Clinical under staging occurred in 50% of patients and pathologic down staging occurred in 18% of patients.
center dot Up staging to muscle invasive disease occurred in 45.9% (n = 592) of 1,291 patients with clinical < T1, including 30.6% of patients with Tis only at transurethral resection.
center dot Of the 3,166 patients with clinically organ confined (OC) tumor stage, 1,357 (42.9%) were up staged to non-organ confined pathologic tumor stage.
center dot Within each clinical stage stratum, patients who were clinically under staged had a higher probability of disease relapse or death from UCB compared to those who were same staged or down staged on pathologic examination (P < 0.05).
CONCLUSIONS
center dot We identified clinical under staging in half of the patients undergoing radical cystectomy for UCB.
center dot Up staging resulted in a higher likelihood of disease progression and eventual death from UCB.
center dot These findings should be considered when utilizing pre-operative risk-adapted strategies for selecting candidates for neoadjuvant chemotherapy.

• 出版日期2011-3