Outcomes Associated with Carcinoma In Situ (pTis) and No Residual Disease (pT0) on Radical Cystectomy
KE Watts, DE Hansel. Cleveland Clinic, Cleveland, OH
Background: With the advent of transurethral resection (TUR) of bladder tumors and neoadjuvant therapies, the finding of pT0 disease at cystectomy is not uncommon and has been associated with improved outcomes relative to the finding of residual disease. We compared the associated pathologic and outcomes findings in consecutive patients with pT0 and pTis disease at cystectomy.
Design: Pathology results and patient data for cystectomies performed between 1991 and 2006 showing pT0 or pTis disease were retrieved from the electronic archives. Prior biopsies and TUR specimens were analzyed to determine the curative intent of the surgical process, volume of tissue resected, focality of disease, and involvement of muscularis propria (MP). Disease-specific outcomes were adjusted for sex, smoking history, prostate cancer history, margin status, and ureter, prostate involvement, or lymph node involvement.
Results: Specimens consisted of 59 pTis and 36 pT0 cystectomy specimens. For the Tis group, ages ranged from 41-86 years (mean 67.5) with a M:F female ratio of 48:11. The pT0 group was similar with an age range of 39-86 years (mean 65.9) and a M:F ratio of 29:7. While the majority of patients in both groups had a history of smoking, a slightly greater proportion of patients in the Tis group had a positive history. Involvement of the MP by disease at biopsy or TUR is correlates with slightly greater mortality in both the pT0 and pTis groups, but did not correlate with greater risk of pTis. Involvement of the ureter, prostate, and margins by disease at cystectomy was only found in patients with pTis. Survival at 1, 2, and 5 years was calculated for both groups and showed no significant differences (p = 0.65) when adjusted for potential confounding factors. Comparison of the volume of tissue sampled on prior biopsy or TUR, as well as assessment of surgical cure, also failed to correlate with any significant differences in outcome.
Conclusions: Although pT0 bladder disease has been suggested to yield improved outcomes relative to residual disease, comparison between pT0 and pTis disease on cystectomy yielded similar disease-specific survival outcomes in multivariate analysis. Of note, intraoperative assessment of prior biospy/TUR material for extent and completeness of resection did not appear to impact outcomes in this study.
Category: Genitourinary (including renal tumors)
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 91, Tuesday Afternoon