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Introduction: Early cystectomy is advocated for clinical stage T1 (cT1) bladder cancer with frequent pathologic upstaging in recent multicenter studies. However, details such as timing, tumor size and completeness of resection prior to cystectomy may be difficult to obtain and were noted as potential confounding variables. Herein we evaluate these factors in a contemporary single institution analysis of cT1 bladder cancer patients undergoing radical cystectomy.
Materials & Methods: From 2000-2011, 120 patients underwent early cystectomy for cT1 disease. Inclusion criteria consisted of documented evidence of visibly complete TURBT and uninvolved muscularis propria in the TUR specimen. Estimated tumor size at TUR and time interval from initial T1 diagnosis to cystectomy were correlated with final pathologic stage.
Results: Of 120 cT1 patients undergoing early radical cystectomy, 51 (42%) satisfied the inclusion criteria. Sixteen (31%) of 51 were upstaged to pT2 (n=6), pT3 (n=7) or pT4 (n=3) disease. Occult nodal metastases were identified in 4 (8%) patients. The mean interval from initial T1 diagnosis to cystectomy was 10.3 months in the non-upstaged group, versus 6.8 months in the upstaged group (p=0.15, t-test). No significant difference in upstaging was observed on the basis of tumor size (p=0.69, Fisher's).
Conclusions: In our series, pathologic upstaging of cT1 bladder cancer occurred in 31% of patients despite visibly complete TURBT. Neither the interval from diagnosis to radical cystectomy nor tumor size at TUR correlated significantly with pathologic stage. Better preoperative staging modalities are needed in assigning cT1 patients to radical cystectomy versus other treatment.