Validation of New Staging System for Patients with Invasive Urothelial Carcinoma of the Prostate
Ranko Miocinovic, Ahmed Abd El Latif, Andrew J Stephenson, Donna Hansel. Cleveland Clinic, Cleveland, OH
Background: To investigate whether the outcome of patients undergoing radical cystectomy (RC) with contiguous involvement of the prostatic urethra by urothelial cancer of the bladder (UCB) varies by the extent of ductal/stromal invasion, and to verify the changes in the new staging system.
Design: A retrospective review identified 103 consecutive patients who underwent RC at two high-volume hospitals who were found to have contiguous involvement of the prostatic urethral ducts +/- stroma with UCB. Patients were divided into two groups according to extent of prostatic invasion: 1) superficial N=48 (ductal involvement [N=6], glandular invasion [N=7] or focal stromal invasion [N=35]), and 2) deep N=55 (deep stromal invasion (N=32), extra capsular invasion or seminal vesicles invasion (N=23)). Multivariable Cox proportional hazards model was used to determine the association of extent of prostatic involvement with mortality after controlling for age, institution, pathological stage, surgical margin status, and lymph node status.
Results: The median follow-up was 18 months (IQR: 8-37). Lymph node metastasis was observed in 27% and 40% of patients in groups 1 and 2, respectively. The 5-year overall survival for groups 1 and 2 was 63% and 40%, respectively (p=0.02). In multivariable analysis, patients with deep stromal invasion had a significantly worse mortality than those with superficial involvement of the prostatic urethra/stroma (HR: 2.6; 95% CI: 1.2-5.9).
Conclusions: Patients with superficial involvement of the prostate by contiguous UCB have a significantly improved survival in comparison to deep invasion. This supports the recent changes in staging system in which patients with ductal and focal stromal invasion are classified as pT2 sage.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 132, Wednesday Afternoon