Urothelial Carcinoma in Bladder Diverticula: A Multicenter Analysis of Characteristics and Clinical Outcomes. European urology focus

Charlotte S. Voskuilen, Roland Seiler, Michael Rink, Cédric Poyet, Aidan P. Noon, Florian Roghmann, Andrea Necchi, Atiqullah Aziz, Alexandre Lavollé, Matthew J. Young, Phillip Marks, Karim Saba, Bas W. G. van Rhijn, Elisabeth E. Fransen van de Putte, Jason Ablat, Peter C. Black, Roman Sosnowski, Jakub Dobruch, Pardeep Kumar, Samer JalladJames W. F. Catto, Evanguelos Xylinas, Kees Hendricksen

Research output: Contribution to journalArticlepeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)1226-1232
Number of pages7
JournalEuropean Urology Focus
Volume6
Issue number6
DOIs
Publication statusPublished - 2020

Keywords

  • *Urothelial carcinoma
  • *Radical cystectomy
  • *Bladder cancer
  • *Bladder diverticulum
  • *Partial cystectomy

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