Risk Factors for DisconcordanceBetween Pre and Post Radical Cystectomy Stages

Abstract

PURPOSE: To investigate the correlation between pre and post surgical staging in patients undergoing radical cystectomy (RC), and study the possibility of predicting their disconcordance.MATERIALS AND METHODS: We reviewed medical records of 186 patients diagnosed with transitional cell carcinoma of the bladder, who had undergone RC between the years 2007 and 2010. We determined the correlation between pre and post surgical stages and then studied the association between stage disconcordance and age, gender, smoking, history of previous transurethral resection of bladder tumor (TURBT) and intravesical treatments, re-TURBT in high-risk superficial bladder tumors, and the treatment delay between diagnosis and RC. Analysis was performed using Chi-Square and Fisher’s Exact tests.RESULTS: Post surgical up-staging occurred in 86 (46.24%) patients and even more (69.35%) if lymph node involvement was also considered as up-staging. Smokers and those with pre surgical stages of ≤ T1 and T2 with no history of re-TURBT had a significantly increased risk of disconcordance. The risk of up-staging was almost halved by an early re-TURBT in high-risk patients.CONCLUSION: Disconcordance between pre and post surgical stages in patients undergoing RC is common. Until better ways of staging are developed, decision making in patients with bladder tumor should be done by extra attention to patients who have risk factors associated with increased risk of up-staging, including smokers and those with nonmuscle-invasive bladder tumors or T2 tumors. An early re-TURBT will decrease the up-staging rate.

Keywords

• urinary bladder neoplasms
• neoplasm staging
• cystectomy
• smoking