Urothelial Carcinoma in Bladder Diverticula

TY - JOUR

T1 - Urothelial Carcinoma in Bladder Diverticula

T2 - A Multicenter Analysis of Characteristics and Clinical Outcomes

AU - Voskuilen, Charlotte S

AU - Seiler, Roland

AU - Rink, Michael

AU - Poyet, Cédric

AU - Noon, Aidan P

AU - Roghmann, Florian

AU - Necchi, Andrea

AU - Aziz, Atiqullah

AU - Lavollé, Alexandre

AU - Young, Matthew J

AU - Marks, Phillip

AU - Saba, Karim

AU - van Rhijn, Bas W G

AU - Fransen van de Putte, Elisabeth E

AU - Ablat, Jason

AU - Black, Peter C

AU - Sosnowski, Roman

AU - Dobruch, Jakub

AU - Kumar, Pardeep

AU - Jallad, Samer

AU - Catto, James W F

AU - Xylinas, Evanguelos

AU - Hendricksen, Kees

AU - Young Academic Urologists’ Working Group on Urothelial Carcinoma of the European Association of Urology

N1 - Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2018

Y1 - 2018

N2 - BACKGROUND: Urothelial carcinoma arising in a bladder diverticulum (UCBD) is uncommon, and data on treatment and outcome are sparse.OBJECTIVE: To analyze clinicopathological characteristics of UCBD and to compare outcome after radical cystectomy (RC) and partial cystectomy (PC).DESIGN, SETTING, AND PARTICIPANTS: Data of 115 UCBD patients treated with RC (n=81) or PC (n=34) between 2000 and 2016 were collected from 11 institutional databases and were analyzed retrospectively. Median follow-up was 5.0yr (95% confidence interval [CI]: 4.0-6.2).OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Upstaging of tumor stage at diagnostic transurethral resection (TUR) to the RC/PC specimen was investigated. Overall survival (OS) and metastasis-free survival (MFS) after RC and PC were analyzed using Kaplan-Meier estimates, and compared using the log-rank test. Intravesical recurrences after PC were reported. A multivariable Cox proportional-hazard model was used to identify factors associated with OS.RESULTS AND LIMITATIONS: There were no statistically significant differences in clinicopathological characteristics between RC and PC groups. Fifty-five percent of patients with cTa/is/1 at diagnostic TUR had ≥pT2 tumors at RC/PC. Five-year OS and MFS were, respectively, 62% and 66% for RC and 66% and 55% for PC (p=0.9 and p=0.6). Intravesical tumor recurrence was seen in six of 34 (18%) PC patients. In multivariable analysis, positive surgical margins and extravesical disease (≥pT2) were associated with worse OS, whereas treatment modality was not (RC: reference; PC: hazard ratio 0.94, [95% CI: 0.47-1.90], p=0.9).CONCLUSIONS: Upstaging of UCBD was frequent, indicating an inaccuracy in clinical staging. We found no differences in OS or MFS between PC and RC groups; therefore, PC may represent a feasible surgical alternative to RC in selected UCBD patients.PATIENT SUMMARY: In this report, we looked at the treatment of urothelial carcinoma arising in a bladder diverticulum (UCBD). We found that bladder-sparing treatment by partial cystectomy may be an alternative to radical cystectomy in carefully selected UCBD patients.

AB - BACKGROUND: Urothelial carcinoma arising in a bladder diverticulum (UCBD) is uncommon, and data on treatment and outcome are sparse.OBJECTIVE: To analyze clinicopathological characteristics of UCBD and to compare outcome after radical cystectomy (RC) and partial cystectomy (PC).DESIGN, SETTING, AND PARTICIPANTS: Data of 115 UCBD patients treated with RC (n=81) or PC (n=34) between 2000 and 2016 were collected from 11 institutional databases and were analyzed retrospectively. Median follow-up was 5.0yr (95% confidence interval [CI]: 4.0-6.2).OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Upstaging of tumor stage at diagnostic transurethral resection (TUR) to the RC/PC specimen was investigated. Overall survival (OS) and metastasis-free survival (MFS) after RC and PC were analyzed using Kaplan-Meier estimates, and compared using the log-rank test. Intravesical recurrences after PC were reported. A multivariable Cox proportional-hazard model was used to identify factors associated with OS.RESULTS AND LIMITATIONS: There were no statistically significant differences in clinicopathological characteristics between RC and PC groups. Fifty-five percent of patients with cTa/is/1 at diagnostic TUR had ≥pT2 tumors at RC/PC. Five-year OS and MFS were, respectively, 62% and 66% for RC and 66% and 55% for PC (p=0.9 and p=0.6). Intravesical tumor recurrence was seen in six of 34 (18%) PC patients. In multivariable analysis, positive surgical margins and extravesical disease (≥pT2) were associated with worse OS, whereas treatment modality was not (RC: reference; PC: hazard ratio 0.94, [95% CI: 0.47-1.90], p=0.9).CONCLUSIONS: Upstaging of UCBD was frequent, indicating an inaccuracy in clinical staging. We found no differences in OS or MFS between PC and RC groups; therefore, PC may represent a feasible surgical alternative to RC in selected UCBD patients.PATIENT SUMMARY: In this report, we looked at the treatment of urothelial carcinoma arising in a bladder diverticulum (UCBD). We found that bladder-sparing treatment by partial cystectomy may be an alternative to radical cystectomy in carefully selected UCBD patients.

KW - Journal Article

U2 - 10.1016/j.euf.2018.12.002

DO - 10.1016/j.euf.2018.12.002

M3 - SCORING: Journal article

C2 - 30559065

JO - EUR UROL FOCUS

JF - EUR UROL FOCUS

SN - 2405-4569

ER -