Clinicopathologic Features of Transurethral Resection of Bladder Tumor (TURBT) for Prediction of TNM Stage of Urothelial Carcinoma of Urinary Bladder
SR Lee, BH Park, YM Cho, JY Ro. University of Ulsan Colleage of Medicine, Asan Medical Center, Seoul, Republic of Korea; The Methodist Hospital, Weil Medical Colleage of Cornell University, Houston, TX
Background: Urothelial carcinoma (UC) is the most common malignant tumor of the urinary bladder, accounting 84% and 79% in male and female patients, respectively. Tumor stage is the most important prognostic factor and presence of proper muscle invasion is critical for the selection of treatment. TURBT is adequate for diagnosis and treatment of superficial UC (T1). Patients with muscle-invasive deep UC ( T2) undergo additional treatment including radical cystectomy (RC). The aim of this study is to analyze tumor characteristics of TURBT and subsequent RC specimens and to find predictors of the final TNM stage of UC in TURBT specimens.
Design: We analyzed clinicopathologic features of 190 UC cases that underwent both TURBT and RC at Asan Medical Center from 1996 to 2006. The two-tier tumor staging system, superficial and deep UC, was applied in the last TURBT before RC and RC specimens. Because TURBT might remove most of UC and then subsequent RC might not represent the tumor stage accurately, the highest tumor stage from TURBT or RC was used to assign the final TNM stage. The TNM stage was divided as low and high stage groups: superficial non-metastatic UC as the low stage group ( stage I) and muscle-invasive or metastatic UC as the high stage group ( stage II).
Results: The TURBT and RC specimens revealed superficial UC in 109 and 64 cases and muscle-invasive UC in 76 and 126 cases, respectively. The depth of tumor invasion of TURBT specimen could not be determined in 5 cases. Among the 185 cases of known tumor stage in TURBT specimens, the stage at RC was identical to TURBT in 140 cases and upstaged in the other 45 cases. Patients with the high TNM stage group, compared to those with the lower TNM stage group, were older and their TURBT specimens demonstrated higher tumor stage and grade and more proportion of invasive tumor and micropapillary components.
Conclusions: These results demonstrate that the tumor stage of TURBT upstaged in RC in 24% of UC cases. Besides older age population, pathologic features including higher tumor stage, grade, and more invasive components and micropapillary histology in TURBT specimens might be useful for the accurate prediction of the final TNM stage of UC.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 94, Tuesday Morning