Discrepancy between clinical and pathological stage: external validation of the impact on prognosis in an international radical cystectomy cohort
Discrepancy between clinical and pathological stage: external validation of the impact on prognosis in an international radical cystectomy cohort
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DOI：
10.1111/j.1464-410x.2010.09628.x
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发表时间：
2011-03-01
影响因子：
4.5
通讯作者：
Dinney, Colin P.
中科院分区：
文献类型：
--
作者：
Svatek, Robert S.;Shariat, Shahrokh F.;Dinney, Colin P.
关于这个问题我们知道些什么？这项研究补充了什么？小型回顾性研究的观察结果表明，相当多接受膀胱癌根治性膀胱切除术的患者在比较临床和病理分期时经历了分期转移（分期上升或下降）。此外，尚不清楚病理性占优是否是独立于病理分期的不良预后特征。我们报告了一项大型国际多中心队列研究，研究对象为接受膀胱癌根治性膀胱切除术且未进行新辅助化疗的患者。我们的研究结果表明，当考虑病理分期时，病理性占优并不是一个独立的不良预后特征。目的：比较一个大型的、多机构的接受根治的患者的临床和病理分期，确定分期差异对预后的影响。患者与方法：本研究收集了来自9个中心的3393例行根治性膀胱切除术和盆腔淋巴结切除术且未进行新辅助化疗的尿路上皮性膀胱癌（UCB）患者的数据。采用回顾性队列设计来评估出现分期差异的患者百分比以及分期差异对UCB疾病复发时间和死亡时间的影响。结果50%的患者出现临床分期不足，18%的患者出现病理分期不足。在1291例临床< T1的患者中，有45.9% （n = 592）出现中心点向上分期为肌肉侵袭性疾病，其中仅经尿道切除的患者占30.6%。3166例临床器官局限（OC）期患者中，1357例（42.9%）上升到非器官局限的病理肿瘤分期。在各临床分期层中，临床分期低的患者在病理检查中疾病复发或死亡的概率高于同分期或低分期的患者（P < 0.05）。结论：在接受根治性膀胱切除术的UCB患者中，我们发现了一半的临床分期不足。中心点向上分期导致疾病进展和最终死于UCB的可能性更高。在采用术前风险适应策略选择新辅助化疗候选人时应考虑这些发现。
What's known on the subject? and What does the study add?Observations from small retrospective studies have indicated that a considerable number of patients undergoing radical cystectomy for bladder cancer experience a stage migration (either upstaging or downstaging) when comparing clinical and pathological staging. In addition, it is unclear if pathological upstaging is an adverse prognostic feature independent of pathological stage.We report the frequency of upstaging and downstaging using a large, international multicentre cohort of patients undergoing radical cystectomy for bladder cancer without neoadjuvant chemotherapy. Our findings indicate that pathological upstaging is not an independent adverse prognostic feature when considering pathological stage.OBJECTIVEcenter dot To compare the clinical and pathologic stage among a large, multi-institutional series of patients undergoing radical and to determine the effect of stage discrepancy on outcomes.PATIENTS AND METHODScenter dot Data was collected from nine centers and 3,393 patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy and pelvic lymphadenectomy without neo-adjuvant chemotherapy.center dot A retrospective cohort design was used to assess the percentage of patients experiencing stage discrepancy and the impact of stage discrepancy on time to disease relapse and time to death from UCB.RESULTScenter dot Clinical under staging occurred in 50% of patients and pathologic down staging occurred in 18% of patients.center dot Up staging to muscle invasive disease occurred in 45.9% (n = 592) of 1,291 patients with clinical < T1, including 30.6% of patients with Tis only at transurethral resection.center dot Of the 3,166 patients with clinically organ confined (OC) tumor stage, 1,357 (42.9%) were up staged to non-organ confined pathologic tumor stage.center dot Within each clinical stage stratum, patients who were clinically under staged had a higher probability of disease relapse or death from UCB compared to those who were same staged or down staged on pathologic examination (P < 0.05).CONCLUSIONScenter dot We identified clinical under staging in half of the patients undergoing radical cystectomy for UCB.center dot Up staging resulted in a higher likelihood of disease progression and eventual death from UCB.center dot These findings should be considered when utilizing pre-operative risk-adapted strategies for selecting candidates for neoadjuvant chemotherapy.