Novara, Giacomo and Svatek, Robert S. and Karakiewicz, Pierre I. and Skinner, Eila and Ficarra, Vincenzo and Fradet, Yves and Lotan, Yair and Isbarn, Hendrik and Capitanio, Umberto and Bastian, Patrick J. and Kassouf, Wassim and Fritsche, Hans-Martin and Izawa, Jonathan I. and Tilki, Derya and Dinney, Colin P. and Lerner, Seth P. and Schoenberg, Mark and Volkmer, Bjoern G. and Sagalowsky, Arthur I. and Shariat, Shahrokh F. (2010) Soft Tissue Surgical Margin Status is a Powerful Predictor of Outcomes After Radical Cystectomy: A Multicenter Study of More Than 4,400 Patients. JOURNAL OF UROLOGY, 183 (6). pp. 2165-2170. ISSN 0022-5347, 1527-3792
Full text not available from this repository. (Request a copy)Abstract
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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INVASIVE BLADDER-CANCER; SURVIVAL; RECURRENCE; NOMOGRAM; cystectomy; prognosis; urinary bladder neoplasms; carcinoma; transitional cell; survival |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 29 Jul 2020 09:04 |
| Last Modified: | 29 Jul 2020 09:04 |
| URI: | https://pred.uni-regensburg.de/id/eprint/24644 |
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