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BJU Int. 2014 Jun;113(6):894-9. doi: 10.1111/bju.12245. Epub 2014 Apr 3.

Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy.

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  • 1Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.



To evaluate predictors of understaging in patients with presumed non-muscle-invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumour (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT.


We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease after TURBT who underwent RC at our institution from April 2000 to July 2011. In all, 60 of these cT1 patients had undergone a restaging TURBT before RC. The primary outcome measure was pathological staging of ≥T2 disease at the time of RC.


In all, 134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumour (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.25-0.76, P = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71-1.00, P = 0.05) were independent risk factors for understaging.


Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumour and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC.

© 2013 The Authors. BJU International © 2013 BJU International.


cystectomy; outcome and process assessment (health care); surgical pathology; urinary bladder; urinary bladder neoplasms

[PubMed - indexed for MEDLINE]
[Available on 2015-06-01]
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