Pathologic upstaging among patients with nonmuscle-invasive bladder cancer (NMIBC) is more likely among older patients and those with lymphovascular invasion (LVI) and certain histologic features, according to study findings presented at the 22nd annual meeting of the Society of Urologic Oncology.
The findings are from a study of 8620 patients with NMIBC who underwent radical cystectomy (RC), of whom 3100 (36%) were upstaged. Age 80 years or older was significantly associated with 1.6-fold greater odds of upstaging compared with age less than 60 years, Ahmed Elshabrawy, MD, and colleagues from UT Health San Antonio in Texas, reported in a poster presentation. LVI was significantly associated with 7.7-fold greater odds of upstaging compared with no LVI. Sarcomatoid and squamous histologies were significantly associated with 1.4- and 6.4-fold greater odds of upstaging, respectively, compared with urothelial disease.
The study also identified predictors of RC, which included younger age, male gender, treatment at academic medical centers, and the presence of LVI and histologic variants. Compared with patients younger than 60 years, those aged 80 years or older had 76% lower odds of RC. Male vs female sex was significantly associated with 22% greater odds of RC. Treatment at academic medical centers was significantly associated with 7.2-fold greater odds of RC. The presence of LVI, compared with its absence, was significantly associated with 4.0-fold greater odds of RC. Pure urothelial vs variant histology was significantly associated with 60% lower odds of RC.
The lower odds of RC among older patients can be attributed to multiple factors, said senior author Ahmed M. Mansour, MD. For example, the procedure is associated with greater morbidity among older patients, he explained. Thus, older patients might opt for other treatment. He and his colleagues recently published study findings in Urologic Oncology demonstrating that advanced age is an independent predictor of patient refusal of RC regardless of comorbidity indices in muscle-invasive bladder cancer.
In the current study, upstaged patients had significantly lower 5-year overall survival compared with patients who were not upstaged (40% vs 71%). Positive surgical margins and neuroendocrine or sarcomatoid variants were significantly associated with higher death risks.
“On a nationwide level, predictable adverse pathological features are associated with pathological upstaging,” the investigators concluded. This upstaging is associated with significantly poor overall survival, especially in patients with non-organ-confined disease, they noted.
“These features should be considered when counseling patients regarding early radical cystectomy,” they wrote.
Elshabrawy A, Dursun F, Wang H, et al. Predictors and outcomes of pathological upstaging in patients with non-muscle-invasive bladder cancer following radical cystectomy. Presented at the 22nd annual meeting of the Society of Urologic Oncology, December 1-3, 2021. Poster 5.
Elshabrawy A, Wang H, Satsangi A, et al. Correlates of refusal of radical cystectomy in patients with muscle-invasive bladder cancer. Urol Oncol. 2021;39:236.e9-236.e20. doi:10.1016/j.urolonc.22020.11.023