1594 PREOPERATIVE PREDICTORS OF PATHOLOGIC UPSTAGING FOLLOWING CYSTECTOMY FOR T1 BLADDER CANCER

INTRODUCTION AND OBJECTIVES: Patients with T1 highgrade (T1HG) bladder cancer represent a unique subset of urothelial carcinoma patients in whom both conservative and radical therapy may be advocated. Proponents of early cystectomy cite high rates of clinical understaging and eventual disease progression with conservative therapies. The purpose of this study was to identify clinical disease characteristics in a large cohort of patients predictive of final pathologic upstaging. METHODS: We performed a retrospective database review of all patients treated with radical cystectomy at 2 university urology centers from 1997–2007. All patients had histologic confirmation of high-grade urothelial cancer invasive into the lamina propria without muscle invasion prior to undergoing radical cystectomy. Pertinent preand postoperative clnical and pathologic factors were recorded and analyzed. Multivariate analysis was performed using Stata statistical software. RESULTS: Ninety patients undergoing radical cystectomy were clinical stage T1. Median age was 67 years (range: 48–87) and 72 patients (80%) were male. 59% of the cohort had multifocal disease and 37% had associated carcinoma in-situ (CIS) on transurethral resection. 51% of patients received intravesical BCG and 14% had other intravesical treatment prior to cystectomy. Thirty patients (33.3%) demonstrated pathologic upstaging at cystectomy, defined as pT2 and/or lymph node involvement. Seven of 90 patients (7.8%) had lymph node metastases at cystectomy, while 17 (18.9%) had extravesical disease. On multivariate analysis (Table 1) the presence of CIS was the only preoperative factor significantly associated with pathologic upstaging at radical cystectomy (p 0.03, OR 0.24 (0.06–0.89)). CONCLUSIONS: Clinical T1HG bladder cancer is an aggressive malignancy with a substantial risk of disease progression. Our data suggests that up to one-third of these patients were clinically understaged, and the presence of concomitant CIS is significantly associated with this finding. The lower incidence of adverse pathologic outcomes (LN , pT2) in our cohort compared to other T1HG series may be due to the emphasis on early cystectomy prior to progression in these patients.