Clinicopathologic Characteristics and Overall Survival in Cystectomy Patients with Bladder Cancer Involving the Lower Gastrointestinal Tract
Amber M D'Souza, Gary S Phillips, Kamal S Pohar, Debra L Zynger. Ohio State University Medical Center, Columbus, OH
Background: Involvement of the gastrointestinal (GI) tract by bladder cancer is rare and documented in only a few case reports with no prognostic information available. The aim of this study was to characterize pathologic staging and analyze survival in patients with histologically proven bladder cancer involving the lower GI tract.
Design: Cystectomy pathology reports from our institution from 2006-2011 were reviewed to identify those with lower GI involvement. All slides were subsequently reviewed by a genitourinary pathologist and re-staged based on the American Joint Committee on Cancer 7th edition Cancer Staging Manual, for which GI involvement is not a criterion. Overall survival (OS) was analyzed using Kaplan-Meier curves and Cox proportional hazard regression models.
Results: The study reviewed 476 cystectomy pathology reports and identified 12 (3%) with lower GI involved by bladder cancer. Location of tumor occurred with similar frequency in the colon, rectum, and small bowel. Half were a variant of urothelial carcinoma (50%) and the remaining were pure urothelial (33%) or pure squamous cell (17%) carcinoma. Heterogeneity in pathologic staging based upon presence of tumor in the GI tract was observed. 27% had increased pT classification and 9% had increased pM classification based upon GI involvement. Lower GI involvement was a negative predictor of survival, with a 1.5 year OS of 25% versus 62% without GI involvement (P < .001), similar to our pT4 patients (OS 26%). In node negative patients, there was a significantly worse 1.5 year OS of 25% with GI involvement compared to 72% in those without tumor in the GI tract (P = .005). At last follow-up (mean survival in remaining living=3.5 years), 2 of the 12 patients were alive.
Conclusions: We provide the first description of patients with bladder cancer in the lower GI tract. Lower GI involvement is a strong negative predictor of survival and behaves comparable to pT4 tumors. There is heterogeneity in pathological staging based on presence of tumor in the GI tract. We recommend that pathologists adhere to the current pT staging guidelines, in which GI involvement is not a criterion, until further research illustrates if and how it should be incorporated. Although outcome is poor, our data reveals survivors of bladder cancer with lower GI involvement and therefore, complete resection should be a consideration.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 149, Wednesday Morning