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J Urol. 2009 Feb;181(2):540-5; discussion 546. doi: 10.1016/j.juro.2008.10.038. Epub 2008 Dec 13.

Comparison of american joint committee on cancer pathological stage T2a versus T2b urothelial carcinoma: analysis of patient outcomes in organ confined bladder cancer.

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  • 1Vanderbilt University Medical Center, Nashville, Tennessee, USA.



We determined whether there is a difference in survival parameters in patients with pathological T2a vs T2b urothelial carcinoma of the bladder.


We reviewed clinical data on patients who underwent radical cystectomy for urothelial carcinoma between 1995 and 2005. Patients with nontransitional cell bladder cancer, nodal disease or unknown nodal status were excluded from review. Of the 790 reviewed patients 123 (15.4%) were diagnosed with lymph node negative pathological T2 urothelial cancer of the bladder. The impact of pathological substaging (pT2a vs pT2b) was examined to determine the effect on overall, disease specific and recurrence-free survival.


Mean patient age was 65.3 years (range 35 to 84). Median overall followup was 29 months (range 0.53 to 144.27). Median followup in patients alive at last followup was 48.3 months (range 1.1 to 139.9). Actuarial overall survival at 5 years was 52.8% in pT2a cases and 49.6% in pT2b cases (p = 0.89). Actuarial disease specific survival at 5 years was 70.6% in pT2a cases and 65.0% in pT2b cases (p = 0.38). Actuarial recurrence-free survival at 5 years was 74.5% in pT2a cases and 76.2% in pT2b cases (p = 0.93).


In this series no significant difference was noted in overall, disease specific and recurrence-free survival when comparing lymph node negative pT2a vs pT2b urothelial cancer of the bladder following radical cystectomy. Future revisions of the American Joint Committee on Cancer staging system may consider simplifying pathological staging by consolidating these substages.

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