May, Matthias and Bastian, Patrick J. and Brookman-May, Sabine and Fritsche, Hans-Martin and Tilki, Derya and Otto, Wolfgang and Bolenz, Christian and Gilfrich, Christian and Trojan, Lutz and Herrmann, Edwin and Moritz, Rudolf and Tiemann, Arne and Mueller, Stefan C. and Ellinger, Joerg and Buchner, Alexander and Stief, Christian G. and Wieland, Wolf F. and Hoefner, Thomas and Hohenfellner, Markus and Haferkamp, Axel and Roigas, Jan and Zacharias, Mario and Nuhn, Philipp and Burger, Maximilian (2013) Gender-specific differences in cancer-specific survival after radical cystectomy for patients with urothelial carcinoma of the urinary bladder in pathologic tumor stage T4a. UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS, 31 (7). pp. 1141-1147. ISSN 1078-1439, 1873-2496
Full text not available from this repository. (Request a copy)Abstract
Background: Bladder cancer (UCB) staged pT4a show heterogeneous outcome after radical cystectomy (RC). No risk model has been established to date. Despite gender-specific differences, no comparative studies exist for this tumor stage. Materials and methods: Cancer-specific survival (CSS) of 245 UCB patients without neoadjuvant chemotherapy staged pT4a, pN0-2, MO after RC were analyzed in a retrospective multi-center study. Seventeen patients were excluded from further analysis due to carcinoma in situ (CIS) of the prostatic urethra and/or positive surgical margins. Average follow-up period was 30 months (IQR: 14-45). The influence of different clinical and histopathologic variables on CSS was determined through uni- and multivariate Cox regression analyses. Two risk groups were generated using factors with independent effect in multivariate models. Internal validity of the prediction model was evaluated by bootstrapping. Results: Eighty-four percent of the patients (n = 192) were male; 72% (n = 165) showed lymphovascular invasion (LVI). The 5-year CSS rate was 31%, and significantly different between male and female (35% vs. 15%, P = 0.003). Multivariate Cox regression modeling, female gender (HR = 1.83, P = 0.008), LVI (HR = 1.92, P = 0.005), and absence of adjuvant chemotherapy (HR = 0.61, P = 0.020) significantly worsened CSS. Two risk groups were generated using these 3 criteria, which differed significantly between each other in CSS (5-year-CSS: 46% vs. 12%, P < 0.001). The c-index value of the risk model was 0.61 (95% CI: 0.53-0.68, P < 0.001). Conclusions: Prognosis in UCB staged pT4a is heterogeneous. Female gender and LVI are adverse factors. Adjuvant chemotherapy seems to improve outcome. The present analysis establishes the first risk model for this demanding tumor stage. (C) 2013 Elsevier Inc. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | TRANSITIONAL-CELL CARCINOMA; Urinary bladder cancer; Urothelial carcinoma; Radical cystectomy; pT4a; Gender; Prognosis; Risk model |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 30 Mar 2020 09:56 |
| Last Modified: | 30 Mar 2020 09:56 |
| URI: | https://pred.uni-regensburg.de/id/eprint/15954 |
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