Overall Survival after Radical Cystectomy for Bladder Cancer Using the New AJCC Pathologic Classification for Prostatic Stromal Invasion
Amit R Patel, Michael C Large, Sandip Prasad, Joshua A Cohn, Antic Tatjana, Jerome B Taxy, Norm D Smith, Gary D Steinberg, Gladell P Paner. University of Chicago, Chicago, IL
Background: In 2010, the American Joint Committee on Cancer (AJCC) reclassified primary staging for bladder cancer to include prostatic stromal invasion directly from bladder cancer and exclude subepithelial invasion of the prostatic urethra as pT4 staging status. We sought to determine whether the changes were reflective of overall survival between pT4 disease and the newly classified pT2 prostatic stromal invasion.
Design: We retrospectively extracted patients in our institutional cystectomy database with pT4 disease. Additionally, we queried the pathology database for all cystectomy specimens with prostatic urethral involvement. We systematically reclassified patients according to the new AJCC staging guidelines and divided the cohort into 2 groups: pT4 (n=56) and reclassified pT2 (n=21). Our primary endpoint was overall survival. We examined demographic factors and pathologic factors for each group.
Results: The two groups did not differ with respect to age, race, Charlson comorbidity index, or tumor size. However, the reclassified pT2 group compared to the pT4 group had a lower rate of lymph node involvement (15% vs 55%, p =0.002) and any positive margins (30% vs 62%, p=0.008). Median overall survival for reclassified pT2 versus pT4 was 18 months versus 8.6 months, p=0.026.
Conclusions: The new AJCC staging for urothelial carcinoma prostatic stromal invasion corresponds to a difference in pathologic outcomes as well as in overall survival for our population. Our results support continued use of the new AJCC staging system for bladder cancer.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 1:00 PM
Platform Session: Section A, Monday Afternoon