Role of Maximal Endoscopic Resection Before Cystectomy for Invasive Urothelial Bladder Cancer |
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| Affiliation: | 1. Department of Urology, University of Washington School of Medicine, Seattle, WA;2. Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA;3. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA;1. Center for Urologic Oncology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH;2. Imaging Institute, Cleveland Clinic, Cleveland, OH;3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH;1. Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 20850 MD, USA;2. Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China;3. Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, 310058 Hangzhou, China;4. Shanxi Cancer Hospital, 030013 Taiyuan, China;5. Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 20850 MD, USA;1. Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland;3. Division of Pediatric Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland;2. Department of Pediatrics, Baylor College of Medicine, Houston, Texas |
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| Abstract: | Introduction/BackgroundThe aim of this study was to examine whether TUR of all visible endophytic tumors performed before RC, with or without NC, affects final pathologic staging.Patients and MethodsWe retrospectively reviewed data from patients with clinical T2-T4N0-1 urothelial carcinoma of the bladder who underwent RC at our institution between July 2005 and November 2011. Degree of TUR was derived from review of operative reports. We used multivariate logistic regression to assess the association of maximal TUR on pT0 status at time of RC.ResultsOf 165 eligible RC patients, 81 received NC. Reported TUR of all visible tumors was performed in 38% of patients who did not receive NC and 48% of NC patients (P = .19). Nine percent of patients who underwent maximal TUR and did not receive NC were pT0, whereas among NC patients, pT0 was seen in 39% and 19% of those with and without maximal TUR, respectively (P = .05). On multivariate analysis in all patients, maximal TUR was associated with a nonsignificant increased likelihood of pT0 status (odds ratio [OR], 2.03; 95% confidence interval [CI], 0.84-4.94), which was significant when we restricted the analysis to NC patients (OR, 3.17; 95% CI, 1.02-9.83).ConclusionMaximal TUR of all endophytic tumors before NC is associated with complete pathologic tumor response at RC. Candidates for NC before RC should undergo resection of all endophytic tumors when feasible. Larger series are warranted to see if maximal TUR leads to improved overall and disease-specific survival. |
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| Keywords: | Bladder cancer Neoadjuvant chemotherapy Pathologic stage Radical cystectomy Transurethral resection |
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