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59 years old man
Hx of stomach adenocarcinoma 20 years
Hx of chemoradiotherapy
cc:gross hematuria
Cytology:doubtful malignancy
PSA: 4.9 5.5
Cr: 1.1
USG: Bladder mass
grade TCC+CIS
prostate:GS 3+4
GI biopsy :NL
Ureteral frozen sections:negative
In all T1 tumours at high risk of progression (i.e. high
grade, multifocality, carcinoma in situ, and tumour
size, as outlined in the EAU EAU: European
Association of Urologyguidelines for Non-muscleinvasive bladder cancer [32]), immediate radical
cystectomy is an option.
In all T1 patients failing intravesical therapy,
cystectomy should be performed.
Urothelial CIS
with prostatic
duct involvement
prostate:GS 3+3
left ureter:CIS
In the case of CIS, an attempt is made to achieve a
negative margin without compromising ureteral
length because nephrectomy is not indicated for CIS
of the uretCIS of the ureter is not independently
associated with a worse outcome following
cystectomy (Lee et al, 2006). Cancer recurrence at
the anastomosis is rare even with a positive margin
showing CIS, but a positive margin is a risk factor for
developing a second primary tumor of the ureter or
renal pelvis (Lee et al, 2006; Raj et al, 2006).
Surveillance ureteroscopy is the most
sensitive means for following patients
with a positive ureteral margin, and
long-term follow-up is required. The
median time to occurrence in one recent
series was 53 months (Wagner et al,
BJU Int. 2012 Mar;109(6):846-54. doi: 10.1111/j.1464-410X.2011.10455.x.
Epub 2011 Aug 4.
Factors influencing post-recurrence survival in bladder cancer following
radical cystectomy.
Bladder cancer recurrence forebodes poor prognosis, with 6 months'
median survival following recurrence. Advanced pathological stage,
positive surgical margins, high lymph node density and early recurrence
portends poorer outcome. Although patients with local recurrence have
a slightly better prognosis, those with disease recurrence at local and
distant sites perform very poorly; nearly 97% of all patients with
recurrence eventually succumb to the disease. Chemotherapy
administration following recurrence may improve survival, although
further studies are needed to exclude selection bias.
J Urol. 2010 Jun;183(6):2165-70. doi:
Soft tissue surgical margin status is a powerful
predictor of outcomes after radical cystectomy: a
multicenter study of more than 4,400 patients.
Positive soft tissue surgical margin is a strong predictor of
recurrence and eventual death from urothelial carcinoma of the
bladder. Soft tissue surgical margin status should always be
reported in the pathological reports after radical cystectomy.
Due to uniformly poor outcomes patients with positive soft tissue
surgical margins should be considered for studies on adjuvant
local and/or systemic therapy.
Eur Urol. 2013 Apr;63(4):739-44. doi:
10.1016/j.eururo.2012.09.053. Epub 2012 Sep 28.
Prognostic value of perinodal lymphovascular invasion following
radical cystectomy for lymph node-positive urothelial carcinoma.
We present the first explorative study on the prognostic impact of
pnLVI. In contrast to other parameters that show the extent of LN
metastasis, pnLVI is an independent prognosticator for CSS.
Prog Urol. 2012 Oct;22(12):705-10. doi: 10.1016/j.purol.2012.07.011. Epub
2012 Aug 29.
[Radical cystectomy for urothelial bladder cancer: prognostic impact of lymph
node metastasis and soft tissue surgical margins].
Positive soft tissue surgical margin and/or lymph node metatstasis on
cystectomy specimen is a strong predictor of GS and SS from
urothelial carcinoma of the bladder. So it is for capsular rupture,
ganglionic density greater or equal to 0.10 and nb of N in
lymphadenectomy less than 14 for pN+ patients.
J Urol. 2007 Dec;178(6):2308-12; discussion 2313. Epub 2007
Oct 22.
Positive surgical margins in soft tissue following radical
cystectomy for bladder cancer and cancer specific survival.
Risk factors for positive soft tissue surgical margins are female gender,
locally advanced cancer, presence of vascular invasion and mixed
histology. Patients with positive soft tissue surgical margins have poor
prognosis, and positive soft tissue surgical margins were found to be
independently associated with disease specific death.
World J Urol. 2011 Aug;29(4):451-6. doi: 10.1007/s00345-010-0581z. Epub 2010 Jul 9.
Sequential resection of malignant ureteral margins at radical
cystectomy: a critical assessment of the value of frozen section
FSA has a high accuracy for detecting malignant ureteral margins.
Patients with positive final margins are at increased risk of UUT-R.
With sequential resection, however, positive margins cannot reliably
be converted to negative ones.
Int Urol Nephrol. 2012 Dec;44(6):1705-10. doi: 10.1007/s11255-012-0224-y.
Epub 2012 Jul 7.
The incidence and relevance of prostate cancer in radical cystoprostatectomy
The majority of incidental CaP in CP specimens are
organ confined and do not influence oncological
outcome. The prognosis of such patients is primarily
determined by bladder cancer. Our findings support
previous reports and autopsy studies elsewhere.