TY - JOUR
T1 - Soft Tissue Surgical Margin Status is a Powerful Predictor of Outcomes After Radical Cystectomy
T2 - A Multicenter Study of More Than 4,400 Patients
AU - Novara, Giacomo
AU - Svatek, Robert S.
AU - Karakiewicz, Pierre I.
AU - Skinner, Eila
AU - Ficarra, Vincenzo
AU - Fradet, Yves
AU - Lotan, Yair
AU - Isbarn, Hendrik
AU - Capitanio, Umberto
AU - Bastian, Patrick J.
AU - Kassouf, Wassim
AU - Fritsche, Hans Martin
AU - Izawa, Jonathan I.
AU - Tilki, Derya
AU - Dinney, Colin P.
AU - Lerner, Seth P.
AU - Schoenberg, Mark
AU - Volkmer, Bjoern G.
AU - Sagalowsky, Arthur I.
AU - Shariat, Shahrokh F.
PY - 2010/6
Y1 - 2010/6
N2 - Purpose: We evaluated the association of soft tissue surgical margins with characteristics and outcomes of patients treated with radical cystectomy for urothelial carcinoma of the bladder. Materials and Methods: We retrospectively collected the data of 4,410 patients treated with radical cystectomy and pelvic lymphadenectomy without neoadjuvant chemotherapy at 12 academic centers in the United States, Canada and Europe. A positive soft tissue surgical margin was defined as presence of tumor at inked areas of soft tissue on the radical cystectomy specimen. Results: Positive soft tissue surgical margins were identified in 278 patients (6.3%). On univariate analysis positive soft tissue surgical margin was significantly associated with advanced pT stage, higher tumor grade, lymphovascular invasion and lymph node metastasis (p <0.001). Actuarial 5-year recurrence-free and cancer specific survival probabilities were 62.8% ± 0.8% and 69% ± 0.8% for patients without soft tissue surgical margins vs 21.6% ± 3.1% and 26.4% ± 3.3% for those with positive soft tissue surgical margins (p <0.001). On multivariable analyses adjusting for the effect of standard clinicopathological features and adjuvant chemotherapy positive soft tissue surgical margin was an independent predictor of disease recurrence and cancer specific mortality (HR 1.52 and HR 1.51, p <0.001, respectively). Soft tissue surgical margin retained independent predictive value in subgroups with advanced disease such as pT3Nany, pT4Nany or Npositive. Conclusions: Positive soft tissue surgical margin is a strong predictor of recurrence and eventual death from urothelial carcinoma of the bladder. Soft tissue surgical margin status should always be reported in the pathological reports after radical cystectomy. Due to uniformly poor outcomes patients with positive soft tissue surgical margins should be considered for studies on adjuvant local and/or systemic therapy.
AB - Purpose: We evaluated the association of soft tissue surgical margins with characteristics and outcomes of patients treated with radical cystectomy for urothelial carcinoma of the bladder. Materials and Methods: We retrospectively collected the data of 4,410 patients treated with radical cystectomy and pelvic lymphadenectomy without neoadjuvant chemotherapy at 12 academic centers in the United States, Canada and Europe. A positive soft tissue surgical margin was defined as presence of tumor at inked areas of soft tissue on the radical cystectomy specimen. Results: Positive soft tissue surgical margins were identified in 278 patients (6.3%). On univariate analysis positive soft tissue surgical margin was significantly associated with advanced pT stage, higher tumor grade, lymphovascular invasion and lymph node metastasis (p <0.001). Actuarial 5-year recurrence-free and cancer specific survival probabilities were 62.8% ± 0.8% and 69% ± 0.8% for patients without soft tissue surgical margins vs 21.6% ± 3.1% and 26.4% ± 3.3% for those with positive soft tissue surgical margins (p <0.001). On multivariable analyses adjusting for the effect of standard clinicopathological features and adjuvant chemotherapy positive soft tissue surgical margin was an independent predictor of disease recurrence and cancer specific mortality (HR 1.52 and HR 1.51, p <0.001, respectively). Soft tissue surgical margin retained independent predictive value in subgroups with advanced disease such as pT3Nany, pT4Nany or Npositive. Conclusions: Positive soft tissue surgical margin is a strong predictor of recurrence and eventual death from urothelial carcinoma of the bladder. Soft tissue surgical margin status should always be reported in the pathological reports after radical cystectomy. Due to uniformly poor outcomes patients with positive soft tissue surgical margins should be considered for studies on adjuvant local and/or systemic therapy.
KW - carcinoma
KW - cystectomy
KW - prognosis
KW - survival
KW - transitional cell
KW - urinary bladder neoplasms
UR - http://www.scopus.com/inward/record.url?scp=77951878964&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77951878964&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2010.02.021
DO - 10.1016/j.juro.2010.02.021
M3 - Article
C2 - 20399473
AN - SCOPUS:77951878964
VL - 183
SP - 2165
EP - 2170
JO - Investigative Urology
JF - Investigative Urology
SN - 0022-5347
IS - 6
ER -