Research and Reports in Urology (Aug 2022)

Outcomes and Prognostic Factors of Patients with Urothelial Carcinoma Undergoing Radical Cystectomy and pT0 in the Final Histology Without Neoadjuvant Chemotherapy

  • Rodler S,
  • Buchner A,
  • Eismann L,
  • Schulz GB,
  • Marcon J,
  • Ledderose S,
  • Schlenker B,
  • Stief CG,
  • Karl A,
  • Jokisch JF

Journal volume & issue
Vol. Volume 14
pp. 281 – 290

Abstract

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Severin Rodler,1 Alexander Buchner,1 Lennert Eismann,1 Gerald Bastian Schulz,1 Julian Marcon,1 Stephan Ledderose,2 Boris Schlenker,1 Christian G Stief,1 Alexander Karl,3 Jan-Friedrich Jokisch1 1Department of Urology, Klinikum der Universität München, Munich, Germany; 2Department of Pathology, Klinikum der Universität München, Munich, Germany; 3Department of Urology, Barmherzige Brüder Krankenhaus München, Munich, GermanyCorrespondence: Severin Rodler, Department of Urology, Klinikum der Universität München, Marchioninistr. 15, München, 81377, Germany, Tel +089 4400 73530, Fax +089 4400 76532, Email [email protected]: Absence of tumor in the final histopathology after radical cystectomy (RC) is a rare but potentially favorable outcome. Therefore, we aimed to analyze outcomes and prognostic factors of patients with urothelial carcinoma (UC) undergoing RC and T0 in the final histology without neoadjuvant chemotherapy at a high-volume academic center.Patients and Methods: We retrospectively analyzed patients undergoing RC for pure UC between 2004 and 2020. Cancer-specific survival (CSS) and overall survival (OS) were calculated using Kaplan–Meier analysis and group comparison by Log rank test. Potential prognostic factors were analyzed using univariate Cox regression models.Results: A total of 1051 patients with UC underwent RC. 72 patients (6.7%) showed pT0 in the final histology. Across all T-stages, 5-year CSS was significantly different with 88% for pT0, 80% for pTa/pTis, 78% for pT1, 76% for pT2, 51% for pT3 and 27% for pT4 in our cohort (p=0.001). Neither instillation therapy (HR 0.31, 95% CI 0.07– 1.43), number of TURB prior RC (HR 1.47, 95% CI 0.25– 6.18), use of photodynamic diagnostics (PDD) (HR 0.64, 95% CI 0.14– 3.02), performing a second resection (HR 0.87, 95% CI 0.27– 2.86), muscle-invasive disease prior RC at any TURB (HR 0.7, 95% CI 0.2– 2.39) or muscle-invasive disease in the TURB prior RC (HR 1.0, 0.31– 3.29) were associated with CSS in univariate analysis.Conclusion: pT0 reveals a survival benefit in patients undergoing RC for UC and therefore presents a distinctive tumor entity. As clinical and cystoscopic characteristics do not improve patient stratification, further research is warranted to define risk groups in this specific tumor entity.Keywords: bladder cancer, radical cystectomy, pT0 status after cystectomy

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