Impact of timing of computed tomography staging and patient factors on the detection of 'true' cN plus bladder cancer
Por:
von Deimling, M, Furrer, M, Bianchi, A, Pichler, R, Maas, M, Tully, KH, Longoni, M, Mertens, LS, Taylor, J, del Giudice, F, Li, R, Gallioli, A, Albisinni, S, Crocetto, F, Velev, M, Afferi, L, Mari, A, Laukhtina, E, Klemm, J, Singla, N, Fisch, M, Spiess, PE, Lotan, Y, Moschini, M, Black, PC, Antonelli, A, Kiss, B, Shariat, SF, Pradere, B
Publicada:
1 nov 2025
Ahead of Print:
1 jul 2025
Resumen:
Objectives To evaluate whether computed tomography (CT) scans should be performed before or after transurethral resection of bladder tumour (TURBT) for accurate lymph node staging in clinically lymph node-positive bladder cancer (BCa). Additionally, to identify patient factors that can aid in predicting lymph node metastasis. Patients and Methods In this retrospective, multicentre study, we analysed patients with cN+ M0 BCa staged by CT and treated with upfront radical cystectomy (RC) and pelvic lymph node dissection. We stratified patients by the interval between TURBT and CT into three groups: (1) before TURBT; (2) within 30 days after TURBT; and (3) more than 30 days post-TURBT. Staging accuracy, defined as concordance between clinical and pathological lymph node status, was evaluated. We utilised logistic regression analyses to identify patient factors, including the optimal timing of staging, in predicting pathological lymph node status at RC. Results Among 183 patients with cN+ disease, 90 (49%) had pN0 disease at RC. Of these, 40, 36 and 14 were staged before TURBT, within 30 days after TURBT, and more than 30 days post-TURBT, respectively (P = 0.2). Pathological downstaging was most common in cN1 (22%) and cN2 (20%) disease. The overall concordance rate was 23%. The timing of staging did not correlate with pathological lymph node status on logistic regression (all P > 0.05). Lymphovascular invasion (LVI) at TURBT was associated with pN status (odds ratio 4.25, confidence interval 2.02-9.34; P < 0.001) at RC. Conclusion Overall, we found no association between the timing of CT-based staging and pathological lymph node metastases in cN+ BCa. The data suggest that performing a TURBT prior to staging does not increase the finding of false-positive nodes on imaging. LVI was the only factor at the time of TURBT associated with pathological lymph node metastasis at RC. Limitations include the multicentre retrospective design and the inclusion of only patients with clinically node-positive disease.
Filiaciones:
von Deimling, M:
Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Furrer, M:
Univ Bern, Univ Hosp Bern, Dept Urol, Bern, Switzerland
Solothurner Spitaler AG, Dept Urol, Olten, Switzerland
Solothurner Spitaler AG, Dept Urol, Solothurn, Switzerland
Bianchi, A:
Univ Verona, Dept Urol, Azienda Osped Univ Integrata, Verona, Italy
Pichler, R:
Med Univ Innsbruck, Comprehens Canc Ctr Innsbruck, Dept Urol, Innsbruck, Austria
Maas, M:
Eberhard Karls Univ Tubingen, Dept Urol, Tubingen, Germany
Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada
Tully, KH:
Ruhr Univ Bochum, Marien Hosp Herne, Dept Urol & Neurourol, Herne, Germany
Longoni, M:
Vita Salute San Raffaele, Urol Res Inst, Dept Urol, Milan, Italy
Mertens, LS:
Netherlands Canc Inst, Dept Urol, Amsterdam, Netherlands
Taylor, J:
Univ Texas Southwestern, Dept Urol, Dallas, TX USA
del Giudice, F:
Sapienza Univ Rome, Policlin Umberto I Hosp, Dept Maternal Infant & Urol Sci, Rome, Italy
Li, R:
H Lee Moffitt Canc Ctr & Res Inst, Dept Genitourinary Oncol, Tampa, FL USA
Gallioli, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Albisinni, S:
Univ Roma Tor Vergata, Tor Vergata Univ Hosp, Dept Surg Sci, Urol Unit, Rome, Italy
Crocetto, F:
Univ Naples Federico II, Dept Neurosci Reprod Sci & Odontostomatol, Naples, Italy
Velev, M:
Univ Paris Saclay, Dept Canc Med, Gustave Roussy, Villejuif, France
Afferi, L:
Luzerner Kantonsspital, Dept Urol, Luzern, Switzerland
Mari, A:
Univ Florence, Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, Florence, Italy
Laukhtina, E:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Klemm, J:
Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
Singla, N:
Johns Hopkins Univ, Sch Med, James Buchanan Brady Urol Inst, Baltimore, MD USA
Johns Hopkins Univ, Sch Med, Dept Urol, Baltimore, MD USA
Fisch, M:
Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
Spiess, PE:
H Lee Moffitt Canc Ctr & Res Inst, Dept Genitourinary Oncol, Tampa, FL USA
Lotan, Y:
Univ Texas Southwestern, Dept Urol, Dallas, TX USA
Moschini, M:
Vita Salute San Raffaele, Urol Res Inst, Dept Urol, Milan, Italy
Black, PC:
Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada
Antonelli, A:
Univ Verona, Dept Urol, Azienda Osped Univ Integrata, Verona, Italy
Kiss, B:
Univ Bern, Univ Hosp Bern, Dept Urol, Bern, Switzerland
Shariat, SF:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Karl Landsteiner Inst Urol & Androl, Vienna, Austria
Univ Texas Southwestern, Dept Urol, Dallas, TX USA
Univ Jordan, Dept Special Surg, Div Urol, Amman, Jordan
Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic
Semmelweis Univ, Dept Urol, Budapest, Hungary
Tabriz Univ Med Sci, Res Ctr Evidence Based Med, Urol Dept, Tabriz, Iran
Pradere, B:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
La Croix Du Sud Hosp, Urosud, Dept Urol, Quint Fonsegrives, France
Green Submitted, hybrid
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