Intravesical tumor involvement of the trigone is associated with nodal metastasis in patients undergoing radical cystectomy

Robert Svatek, Timothy N. Clinton, Clark A. Wilson, Ashish M. Kamat, H. Barton Grossman, Colin P. Dinney, Jay B. Shah

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Abstract

Objective To evaluate the influence of intravesical tumor location on nodal metastasis and mortality after cystectomy. The microvascular anatomy of the urinary bladder is variable in distinct regions of the bladder and thus tumor location may influence the tumors' ability to access lymphatic and vascular structures.

Materials and Methods An observational cohort study was conducted of all patients undergoing radical cystectomy at a single institution between January 2000 and July 2008. Tumor location was classified into the following 6 locations: lateral wall, posterior wall, anterior wall, trigone, dome, and bladder neck. The association between tumor location with nodal metastasis and cancer-specific mortality was assessed.

Results A total of 545 patients were identified in this cohort. Location of tumor at the bladder trigone was associated with an increased likelihood of nodal metastasis on univariate (odds ratio, 1.63; 95% confidence interval [CI], 1.01-2.62) and multivariate (odds ratio, 1.83; 95% CI 1.11-2.99) analysis. In addition, trigone location was associated with a decreased cancer-specific survival on univariate (hazard ratio, 1.49; 95% CI, 1.03-2.16) and multivariate (hazard ratio, 1.68; 95% CI, 1.11-2.55) analysis.

Conclusion Patients with bladder tumor in the trigone have a greater risk of lymph node metastasis at cystectomy and decreased cancer-specific survival. Tumor location may be a useful prognostic factor in risk stratification of patients with invasive bladder cancer.

Original languageEnglish (US)
Pages (from-to)1147-1151
Number of pages5
JournalUrology
Volume84
Issue number5
DOIs
StatePublished - Nov 1 2014

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Cystectomy
Neoplasm Metastasis
Urinary Bladder Neoplasms
Neoplasms
Confidence Intervals
Urinary Bladder
Odds Ratio
Survival
Mortality
Observational Studies
Blood Vessels
Anatomy
Cohort Studies
Lymph Nodes

ASJC Scopus subject areas

  • Urology

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Intravesical tumor involvement of the trigone is associated with nodal metastasis in patients undergoing radical cystectomy. / Svatek, Robert; Clinton, Timothy N.; Wilson, Clark A.; Kamat, Ashish M.; Grossman, H. Barton; Dinney, Colin P.; Shah, Jay B.

In: Urology, Vol. 84, No. 5, 01.11.2014, p. 1147-1151.

Research output: Contribution to journalArticle

Svatek, Robert ; Clinton, Timothy N. ; Wilson, Clark A. ; Kamat, Ashish M. ; Grossman, H. Barton ; Dinney, Colin P. ; Shah, Jay B. / Intravesical tumor involvement of the trigone is associated with nodal metastasis in patients undergoing radical cystectomy. In: Urology. 2014 ; Vol. 84, No. 5. pp. 1147-1151.
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abstract = "Objective To evaluate the influence of intravesical tumor location on nodal metastasis and mortality after cystectomy. The microvascular anatomy of the urinary bladder is variable in distinct regions of the bladder and thus tumor location may influence the tumors' ability to access lymphatic and vascular structures.Materials and Methods An observational cohort study was conducted of all patients undergoing radical cystectomy at a single institution between January 2000 and July 2008. Tumor location was classified into the following 6 locations: lateral wall, posterior wall, anterior wall, trigone, dome, and bladder neck. The association between tumor location with nodal metastasis and cancer-specific mortality was assessed.Results A total of 545 patients were identified in this cohort. Location of tumor at the bladder trigone was associated with an increased likelihood of nodal metastasis on univariate (odds ratio, 1.63; 95{\%} confidence interval [CI], 1.01-2.62) and multivariate (odds ratio, 1.83; 95{\%} CI 1.11-2.99) analysis. In addition, trigone location was associated with a decreased cancer-specific survival on univariate (hazard ratio, 1.49; 95{\%} CI, 1.03-2.16) and multivariate (hazard ratio, 1.68; 95{\%} CI, 1.11-2.55) analysis.Conclusion Patients with bladder tumor in the trigone have a greater risk of lymph node metastasis at cystectomy and decreased cancer-specific survival. Tumor location may be a useful prognostic factor in risk stratification of patients with invasive bladder cancer.",
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T1 - Intravesical tumor involvement of the trigone is associated with nodal metastasis in patients undergoing radical cystectomy

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AU - Clinton, Timothy N.

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AU - Grossman, H. Barton

AU - Dinney, Colin P.

AU - Shah, Jay B.

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N2 - Objective To evaluate the influence of intravesical tumor location on nodal metastasis and mortality after cystectomy. The microvascular anatomy of the urinary bladder is variable in distinct regions of the bladder and thus tumor location may influence the tumors' ability to access lymphatic and vascular structures.Materials and Methods An observational cohort study was conducted of all patients undergoing radical cystectomy at a single institution between January 2000 and July 2008. Tumor location was classified into the following 6 locations: lateral wall, posterior wall, anterior wall, trigone, dome, and bladder neck. The association between tumor location with nodal metastasis and cancer-specific mortality was assessed.Results A total of 545 patients were identified in this cohort. Location of tumor at the bladder trigone was associated with an increased likelihood of nodal metastasis on univariate (odds ratio, 1.63; 95% confidence interval [CI], 1.01-2.62) and multivariate (odds ratio, 1.83; 95% CI 1.11-2.99) analysis. In addition, trigone location was associated with a decreased cancer-specific survival on univariate (hazard ratio, 1.49; 95% CI, 1.03-2.16) and multivariate (hazard ratio, 1.68; 95% CI, 1.11-2.55) analysis.Conclusion Patients with bladder tumor in the trigone have a greater risk of lymph node metastasis at cystectomy and decreased cancer-specific survival. Tumor location may be a useful prognostic factor in risk stratification of patients with invasive bladder cancer.

AB - Objective To evaluate the influence of intravesical tumor location on nodal metastasis and mortality after cystectomy. The microvascular anatomy of the urinary bladder is variable in distinct regions of the bladder and thus tumor location may influence the tumors' ability to access lymphatic and vascular structures.Materials and Methods An observational cohort study was conducted of all patients undergoing radical cystectomy at a single institution between January 2000 and July 2008. Tumor location was classified into the following 6 locations: lateral wall, posterior wall, anterior wall, trigone, dome, and bladder neck. The association between tumor location with nodal metastasis and cancer-specific mortality was assessed.Results A total of 545 patients were identified in this cohort. Location of tumor at the bladder trigone was associated with an increased likelihood of nodal metastasis on univariate (odds ratio, 1.63; 95% confidence interval [CI], 1.01-2.62) and multivariate (odds ratio, 1.83; 95% CI 1.11-2.99) analysis. In addition, trigone location was associated with a decreased cancer-specific survival on univariate (hazard ratio, 1.49; 95% CI, 1.03-2.16) and multivariate (hazard ratio, 1.68; 95% CI, 1.11-2.55) analysis.Conclusion Patients with bladder tumor in the trigone have a greater risk of lymph node metastasis at cystectomy and decreased cancer-specific survival. Tumor location may be a useful prognostic factor in risk stratification of patients with invasive bladder cancer.

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