Effects of Pathologic Re-Review on Tumor Stage, Grade, and Risk Stratification - Expert Commentary
The investigators collected data for 173 patients, 113 with <cT2 disease and 60 with cT2 disease, and evaluated changes in grade and stage. Upon re-review of patients with <cT2 disease, 11% had upgrading, 7% exhibited downgrading, and 82% did not change in grading. Upgrading was most common in patients with Ta disease (17%), while downgrading was most common among Tis patients (40%). In the <cT2 group, 5% of patients exhibited increased clinical stage, 5% exhibited decreased stage, and 89% exhibited no change in stage upon re-review. Among Tis patients, 40% exhibited a decrease in stage, while 10% exhibited an increase in stage. No patients with cT2 disease were upstaged and 5% were downstaged to NMIBC. In patients with <cT2 disease, re-review led to increased risk stratification in 13% of patients and decreased risk stratification in 8% of patients.
The findings from this study highlight the need for integrating pathologic re-review in the clinical workflow of patients with NMIBC to allow for more accurate risk stratification. Due to the heterogeneity of NMIBC, this will improve effective treatment selection. The feasibility and cost effectiveness of this additional step can be evaluated across institutions. Further studies will be valuable for characterizing more specific benefits and guidelines for re-review.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
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