Microscopic and gross extravesical extension in pathological staging of XXXX .

@entity1 @entity150 @entity1606 @entity5
PURPOSE: We evaluated clinical outcomes in @entity1 with pathological microscopic (pT3a) and gross (pT3b) extravesical @entity5 extension with @entity1606 ( @entity1606 ) of the bladder following radical cystectomy. MATERIALS AND METHODS: A total of 236 @entity1 , including 173 males (73%) and 63 females, underwent radical cystectomy for pathological primary @entity150 with extravesical extension (pT3), of whom 69 (29%) had pT3a and 167 (71%) had pT3b disease. At a median followup of 8.9 years (range 0 to 19.4) lymph node involvement, local and distant recurrences, and clinical outcomes were determined. RESULTS: Of the 236 @entity1 with pT3 @entity5 106 (45%) had lymph node positive disease, including 34 of 69 (49%) with pT3a and 72 of 167 (43%) with pT3b disease. The 10-year recurrence-free survival rate for @entity1 with pT3a @entity5 was 48% compared with 47% for those with pT3b disease (p = 0.89). Recurrence-free survival was significantly better in @entity1 with lymph node negative disease than in those with positive lymph nodes irrespective of the extent of extravesical involvement (pT3a vs pT3b). Local pelvic recurrence developed in 13 of the 236 @entity1 (6%), while 84 (36%) had distant metastatic disease. Of the @entity1 with recurrence, the type of recurrence (local or distant) was not associated with @entity5 stage (pT3a vs pT3b, p = 0.71). Lymph node involvement was a significant risk factor for distant @entity5 recurrence (p <0.001). CONCLUSIONS: Differentiating between microscopic (pT3a) and gross (pT3b) extravesical @entity5 involvement of @entity1606 as outlined in the revised 1997 TNM staging system does not appear to have prognostic significance.
