[Comparison of TNM staging of bladder cancer before and after radical cystectomy: a retrospective clinical- radiological- pathological study]

ABSTRACT

Radical cystectomy is the most effective therapeutic approach for patients with muscleinvasive bladder cancer. Accurate staging is important for treatment planning, and prognostication. This study retrospectively compared TNM staging before and after radical cystectomy in a series of patients with bladder cancer. Between 1/1/2007 and 30/12/2009, 162 patients with urothelial bladder carcinoma who were candidates for Radical cystectomy with curative intent were retrospectively evaluated. Preoperative clinical and pathological [i.e. TURBT] features were compared to pathological outcomes in the cystectomy specimen [TNM staging before and after radical cystectomy]. Our study population comprised 7.41% females and 92.59% males. The median patient age was 65 years [range 40-73]. In 70.37% of patients radical cystectomy was indicated after the progression of an initially superficial bladder carcinoma. In the other 29.63% of patients, bladder neoplasms were muscle-invasive at the time of initial diagnosis. The median time interval between diagnosis of muscle invasion and radical cystectomy was 4 weeks [range 0-72]. T staging of the primary tumour before radical cystectomy was recurrent multifocal [CIS] or [cT1] in 16.05%, [cT2] in 44.44%, [cT3] in 29.63% and [cT4] stage in 9.88% of patients. Whereas T staging after radical cystectomy was distributed as follows 9.88% of patients had stage lymph node involvement was diagnosed in 36 patients [22.22%], foreseen on pelvic CT in only 15 [9.26%]. Clinical and pathologic stages [TNM before and after radical cystectomy] were identical in 46.91% of patients. Pathologic upstaging occurred in 48.15% of primary tumours and in 61.11% of tumours when lymph node involvement was also considered as upstaging. Pathologic downstaging occurred in 22.1% of patients. TNM staging discrepancy before and after radical cystectomy is a relatively common finding after extirpative surgery for bladder cancer. More-accurate clinical staging before cystectomy would allow appropriate treatment strategy and timing for patients with bladder cancer. These data supports the need for more accurate imaging modalities, and to repeat a second staging TUR to reduce the risk of staging errors