부산대학교 도서관

The prognostic implications of urothelial cell carcinoma (UCC) with invasion into the prostatic stroma vary significantly based on the pattern of invasion. In addition to local invasion, variant histologic subtypes represent high-risk features associated with poor outcomes. Early identification of these nuanced pathologic features aids in treatment selection and patient counseling but can be difficult to identify. In the present study, we sought to assess the diagnostic capabilities of TURBT and pre-cystectomy imaging to characterize these patients. We also sought to assess their pathologic and survival outcomes. A prospectively maintained institutional database included 232 men who underwent radical cystectomy for bladder UCC between 2013-2021, 30 of whom had UCC invasion into the prostatic stroma. Patients were stratified by presence of variant histology and route of prostatic stromal spread, either with direct extension from the bladder (bladder primary pT4a, N=13), extension from the prostatic urethra (urethral primary pT2, N=13), or with synchronous routes of stromal invasion (N=4), in accordance with the 8th Edition AJCC Staging Manual. All pathology was re-reviewed for accuracy by an expert genitourinary pathologist. One-year recurrence free survival (RFS) and overall survival (OS) were calculated with Kaplan-Meier analyses. Of the 30 men included, 60% had variant histology, including 71% of patients with any pT4a invasion. Upon review, 3/30 required reclassification from bladder pT4a to pT2 due to staging errors. Of those with variant histology on final pathology, this was identified on the TURBT in 50% of urethral T2, 11% of bladder T4a, and 50% of synchronous cases. Pre-cystectomy imaging suggested T4 UCC in 18% of pT4 patients (Table 1).;;Median OS for urethral T2 was greater than bladder T4a (41 vs. 6 mo, p=.0002) and was greater for T4a non-variant than variant (19 vs. 4.5 mo, p=.048).; One-year RFS was greater for the urethral T2 group than those with bladder T4a (72% vs. 25%, p=.02), (Figure 1). Appropriate staging of prostatic stromal invasive UCC is a nuanced process with significant implications for OS and RFS. Variant histology in these patients may have a higher prevalence than has previously been reported. The diagnostic value of TURBT and pre-cystectomy imaging is of limited value for identification of variant histology and prostatic stromal invasion, suggesting an increased need for the development of novel prognostic tools. [ABSTRACT FROM AUTHOR]