PTU - Polskie Towarzystwo Urologiczne
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CODE: 8.2 - Comparision of clinical and pathological staging of bladder cancer after radical cystectomy
Article published in Urologia Polska 2006/59/Suplement 1.


Michał Szymański, Artur A. Antoniewicz, Przemysław Szostek, Jakub Dobruch, Andrzej Borówka
Klinika Urologii CMKP w Warszawie


Introduction. Tumor stage, defined by TNM system T - tumor, N - nodules, M - metastases is the issue of the great importance in choosing the way of treatment of bladder cancer patients. Patients with tumor infiltrating the muscular tissue of the bladder (cT 2), showed in clinical evaluation, are qualified to radical cystectomy (CR). Similarly, patients with superficial bladder cancer (T1 lub CIS) of large degree of malignancy (G3) are treated by the same method. Diagnostic examinations, e.g TAUS, IVP as well as CT and X-chest ray (or CT) are used in the process of evaluation of the clinical stage of BC. Sometimes bone scan is useful, too. However, the most important data come from histopathological examination (H-P) of the specimen obtained during transurethral resection of the bladder tumor (TURBT). It is common that clinical stage (cT) of BC is lower then pathological stage (pT).
Objectives. To compare clinical and pathological staging of bladder cancer in patients after radical cystectomy.
Materials and methods. 112 patients (99 men, 13 women) aged from 36 to 84 (average 59) years treated by CR due to invasive (cTł2) or resistant to conservative therapy superficial bladder cancer were analyzed. Conformity of cT, evaluated on the basis of histopathological examination (H-P) with pT defined on the H-P of the specimen after RC was assessed. Additionally, tumor grade defined before and after RC was analyzed.
Results. Correlation between cT and pT occurred in 53 (47.3%) patients. 42 (37.5%) patients were understaged. 12 11% patients were overstaged and 5 (4.2%) patients, who underwent CR due to TCC cT2 had no tumor in cystectomy specimens. Tumor grade was understaged and overstaged in 2 (1.7%) and in 12 (10.7%) cases respectively. In the rest 98 (87.6%) cases tumor grade assessed before and after the treatment was the same.
Conclusions. Lack of correlation between clinical and pathological stage of bladder tumor in our material was found in almost 50% cases. Patients who had pT0 after RC present another problem. In this group there are cases with BC cT2 treated by complete TURBT. Both under- and overstaging of bladder tumor grade occurred in 12.4% patients.