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Quality of Diagnostic Staging in Patients with Bladder Cancer: A Process-Outcomes Link
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Oct 22 2014
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Source: Cancer. 121(3):379-385.
Details:
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Alternative Title:Cancer
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Personal Author:
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Description:Background:
Muscle sampling is often used as a surrogate for staging quality in patients with bladder cancer. We examined the association of staging quality at diagnosis and survival among patients with bladder cancer.
Methods:
We reviewed the clinical records of all individuals within the Los Angeles SEER Registry with an incident diagnosis of non-muscle-invasive bladder cancer in 2004–2005. We recorded patient demographics, tumor characteristics, staging quality (presence of muscle in the specimen and mention of muscle in the pathology report), and vital status. Using mixed-effects and competing-risks regression analyses, we quantified the association of patient and tumor characteristics on staging quality and cancer-specific survival.
Results:
Our sample included 1,865 patients, 335 urologists, and 278 pathologists. Muscle was reported as present in 972 (52.1%), reported as absent in 564 (30.2%), and was not mentioned in 329 (17.7%) of the initial pathology reports. The presence of muscle did not differ according to grade or depth of invasion. Mortality was associated with staging quality (p<0.05). Among patients with high-grade disease, 5-year cancer-specific mortality was 8.0%, 13.0%, and 21.5%, respectively, when muscle was present, absent, or not mentioned.
Conclusions:
The omission of muscle in the specimen or its mention in the pathology report in nearly half of all diagnostic resections is associated with increased mortality, particularly in patients with high-grade disease. Because urologists cannot reliably discern between high- and low-grade or Ta and T1 disease, we contend that patients with bladder cancer should undergo adequate muscle sampling at the time of endoscopic resection.
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Pubmed ID:25339141
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Pubmed Central ID:PMC6209593
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Funding:
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Volume:121
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Issue:3
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