Urothelial Carcinoma with Prostatic Stromal Invasion: Does Extent of Stromal Invasion Significantly Impact Patient Outcome?
IV Oliva, SL Smith, AO Osunkoya. Emory University School of Medicine, Atlanta, GA
Background: Urothelial carcinoma (UCa) of the bladder with prostatic stromal invasion is included in stage pT4a of the TNM classification. Despite being a strong indicator of poor prognosis, there have been few large studies investigating the impact of extent of prostatic stromal invasion on patient outcome.
Design: A search of the surgical pathology and expert consultation files at our institution was made for cystoprostatectomy specimens diagnosed as UCa with prostatic stromal invasion from 2002 to 2009. Cases were further stratified as follows: group 1 – focal prostatic stromal invasion and group 2 – extensive prostatic stromal invasion. Only cases with available follow up information were selected.
Results: 35 cases of Uca with prostatic stromal invasion and follow up information were identified. Mean patient age was 70 years (range 44-88 years). Of these 35 patients, 15 (43%) had focal prostatic stromal invasion and 20 (57%) had extensive prostatic stromal invasion. Angiolymphatic invasion was identified in 93% of group 1 cases and 79% of group 2 cases. Positive margins were identified in 50% of group 1 cases and 45% of group 2 cases. Incidence of nodal metastasis was 64% for group 1 and 60% for group 2. 4 of 15 cases (27%) in group 1 and 6 of 20 cases (30%) in group 2 had various histologic variants identified. In group 1: 2 cases of UCa with micropapillary features and UCa with focal squamous differentiation. In group 2: 3 cases of UCA with focal squamous differentiation, 2 cases of UCa with focal sarcomatoid differentiation and 1 case of UCa with focal micropapillary features. One and three-year overall survival for group 1 was 53% and 13%, respectively. One and three-year overall survival for group 2 was 40% and 15%, respectively. Mean survival was 17.4 and 16.3 months for group 1 and 2, respectively. Overall survival curves did not show a statistically significant difference (p = 0.61) between the two groups.
Conclusions: Though one-year survival rates and mean survival appeared to be slightly better for patients with focal vs extensive prostatic stromal invasion, our study suggests that extent of prostatic stromal invasion by UCa of the bladder as an independent factor, does not impact overall patient survival. Other well known prognostic factors including margin status, aggressive components of UCa, angiolymphatic invasion and distant metastasis play a more critical role in predicting patient outcome between the two groups.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 132, Monday Morning