Macroscopic, but not microscopic, perivesical fat invasion at radical cystectomy is an adverse predictor of recurrence and survival

Patrick J. Bastian, Georg C. Hutterer, Shahrokh F. Shariat, Craig G. Rogers, Ganesh S. Palapattu, Yair Lotan, Amnon Vazina, Gilad E. Amiel, Amit Gupta, Arthur I. Sagalowsky, Seth P. Lerner, Mark P. Schoenberg, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

OBJECTIVE: To examine whether the presence of microscopic (pT3a) or macroscopic (pT3b) disease worsens the prognosis relative to pT2 disease at radical cystectomy, as the prognostic significance of pT3a vs pT3b perivesical fat invasion (pT3) is controversial. PATIENTS AND METHODS: In all, 242 patients with pT3 disease (pT3a in 88, pT3b in 121) had radical cystectomy and bilateral pelvic lymphadenectomy for transitional cell carcinoma of the urinary bladder; they were compared with 172 who had organ-confined muscle-invasive disease (pT2). For the analyses we used univariable and multivariable Cox regression models of recurrence and cancer-specific survival, adjusted for age, tumour grade, lymphovascular invasion and the presence of lymph node metastases. RESULTS: In multivariable analyses, microscopic perivesical fat extension (pT3a) was not associated with higher recurrence (P = 0.3) or the mortality rate (P = 0.06) vs pT2 disease. Conversely, the presence of deep perivesical fat extension (pT3b) was associated with 1.8 times the rate of recurrence (P = 0.002) and with twice the rate of death (P = 0.001) vs pT2 disease. CONCLUSION: These findings imply that a detailed assessment of the cystectomy specimen for the presence of microscopic perivesical fat invasion might not be necessary, as the presence of pT3a disease has no strong effect on recurrence or mortality. Moreover, patients with pT3a disease might not require more aggressive therapy than their counterparts with pT2 disease. However, further validation of our data is required.

Original languageEnglish (US)
Pages (from-to)450-454
Number of pages5
JournalBJU International
Volume101
Issue number4
DOIs
StatePublished - Feb 2008
Externally publishedYes

Fingerprint

Cystectomy
Fats
Recurrence
Survival
Mortality
Transitional Cell Carcinoma
Lymph Node Excision
Proportional Hazards Models
Neoplasms
Urinary Bladder
Lymph Nodes
Neoplasm Metastasis
Muscles

Keywords

  • Bladder cancer
  • Cystectomy
  • Recurrence
  • Stage
  • Survival

ASJC Scopus subject areas

  • Urology

Cite this

Bastian, P. J., Hutterer, G. C., Shariat, S. F., Rogers, C. G., Palapattu, G. S., Lotan, Y., ... Karakiewicz, P. I. (2008). Macroscopic, but not microscopic, perivesical fat invasion at radical cystectomy is an adverse predictor of recurrence and survival. BJU International, 101(4), 450-454. https://doi.org/10.1111/j.1464-410X.2007.07213.x

Macroscopic, but not microscopic, perivesical fat invasion at radical cystectomy is an adverse predictor of recurrence and survival. / Bastian, Patrick J.; Hutterer, Georg C.; Shariat, Shahrokh F.; Rogers, Craig G.; Palapattu, Ganesh S.; Lotan, Yair; Vazina, Amnon; Amiel, Gilad E.; Gupta, Amit; Sagalowsky, Arthur I.; Lerner, Seth P.; Schoenberg, Mark P.; Karakiewicz, Pierre I.

In: BJU International, Vol. 101, No. 4, 02.2008, p. 450-454.

Research output: Contribution to journalArticle

Bastian, PJ, Hutterer, GC, Shariat, SF, Rogers, CG, Palapattu, GS, Lotan, Y, Vazina, A, Amiel, GE, Gupta, A, Sagalowsky, AI, Lerner, SP, Schoenberg, MP & Karakiewicz, PI 2008, 'Macroscopic, but not microscopic, perivesical fat invasion at radical cystectomy is an adverse predictor of recurrence and survival', BJU International, vol. 101, no. 4, pp. 450-454. https://doi.org/10.1111/j.1464-410X.2007.07213.x
Bastian, Patrick J. ; Hutterer, Georg C. ; Shariat, Shahrokh F. ; Rogers, Craig G. ; Palapattu, Ganesh S. ; Lotan, Yair ; Vazina, Amnon ; Amiel, Gilad E. ; Gupta, Amit ; Sagalowsky, Arthur I. ; Lerner, Seth P. ; Schoenberg, Mark P. ; Karakiewicz, Pierre I. / Macroscopic, but not microscopic, perivesical fat invasion at radical cystectomy is an adverse predictor of recurrence and survival. In: BJU International. 2008 ; Vol. 101, No. 4. pp. 450-454.
@article{e0383254b2df4c718d537d9a2d7d5aa3,
title = "Macroscopic, but not microscopic, perivesical fat invasion at radical cystectomy is an adverse predictor of recurrence and survival",
abstract = "OBJECTIVE: To examine whether the presence of microscopic (pT3a) or macroscopic (pT3b) disease worsens the prognosis relative to pT2 disease at radical cystectomy, as the prognostic significance of pT3a vs pT3b perivesical fat invasion (pT3) is controversial. PATIENTS AND METHODS: In all, 242 patients with pT3 disease (pT3a in 88, pT3b in 121) had radical cystectomy and bilateral pelvic lymphadenectomy for transitional cell carcinoma of the urinary bladder; they were compared with 172 who had organ-confined muscle-invasive disease (pT2). For the analyses we used univariable and multivariable Cox regression models of recurrence and cancer-specific survival, adjusted for age, tumour grade, lymphovascular invasion and the presence of lymph node metastases. RESULTS: In multivariable analyses, microscopic perivesical fat extension (pT3a) was not associated with higher recurrence (P = 0.3) or the mortality rate (P = 0.06) vs pT2 disease. Conversely, the presence of deep perivesical fat extension (pT3b) was associated with 1.8 times the rate of recurrence (P = 0.002) and with twice the rate of death (P = 0.001) vs pT2 disease. CONCLUSION: These findings imply that a detailed assessment of the cystectomy specimen for the presence of microscopic perivesical fat invasion might not be necessary, as the presence of pT3a disease has no strong effect on recurrence or mortality. Moreover, patients with pT3a disease might not require more aggressive therapy than their counterparts with pT2 disease. However, further validation of our data is required.",
keywords = "Bladder cancer, Cystectomy, Recurrence, Stage, Survival",
author = "Bastian, {Patrick J.} and Hutterer, {Georg C.} and Shariat, {Shahrokh F.} and Rogers, {Craig G.} and Palapattu, {Ganesh S.} and Yair Lotan and Amnon Vazina and Amiel, {Gilad E.} and Amit Gupta and Sagalowsky, {Arthur I.} and Lerner, {Seth P.} and Schoenberg, {Mark P.} and Karakiewicz, {Pierre I.}",
year = "2008",
month = "2",
doi = "10.1111/j.1464-410X.2007.07213.x",
language = "English (US)",
volume = "101",
pages = "450--454",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Macroscopic, but not microscopic, perivesical fat invasion at radical cystectomy is an adverse predictor of recurrence and survival

AU - Bastian, Patrick J.

AU - Hutterer, Georg C.

AU - Shariat, Shahrokh F.

AU - Rogers, Craig G.

AU - Palapattu, Ganesh S.

AU - Lotan, Yair

AU - Vazina, Amnon

AU - Amiel, Gilad E.

AU - Gupta, Amit

AU - Sagalowsky, Arthur I.

AU - Lerner, Seth P.

AU - Schoenberg, Mark P.

AU - Karakiewicz, Pierre I.

PY - 2008/2

Y1 - 2008/2

N2 - OBJECTIVE: To examine whether the presence of microscopic (pT3a) or macroscopic (pT3b) disease worsens the prognosis relative to pT2 disease at radical cystectomy, as the prognostic significance of pT3a vs pT3b perivesical fat invasion (pT3) is controversial. PATIENTS AND METHODS: In all, 242 patients with pT3 disease (pT3a in 88, pT3b in 121) had radical cystectomy and bilateral pelvic lymphadenectomy for transitional cell carcinoma of the urinary bladder; they were compared with 172 who had organ-confined muscle-invasive disease (pT2). For the analyses we used univariable and multivariable Cox regression models of recurrence and cancer-specific survival, adjusted for age, tumour grade, lymphovascular invasion and the presence of lymph node metastases. RESULTS: In multivariable analyses, microscopic perivesical fat extension (pT3a) was not associated with higher recurrence (P = 0.3) or the mortality rate (P = 0.06) vs pT2 disease. Conversely, the presence of deep perivesical fat extension (pT3b) was associated with 1.8 times the rate of recurrence (P = 0.002) and with twice the rate of death (P = 0.001) vs pT2 disease. CONCLUSION: These findings imply that a detailed assessment of the cystectomy specimen for the presence of microscopic perivesical fat invasion might not be necessary, as the presence of pT3a disease has no strong effect on recurrence or mortality. Moreover, patients with pT3a disease might not require more aggressive therapy than their counterparts with pT2 disease. However, further validation of our data is required.

AB - OBJECTIVE: To examine whether the presence of microscopic (pT3a) or macroscopic (pT3b) disease worsens the prognosis relative to pT2 disease at radical cystectomy, as the prognostic significance of pT3a vs pT3b perivesical fat invasion (pT3) is controversial. PATIENTS AND METHODS: In all, 242 patients with pT3 disease (pT3a in 88, pT3b in 121) had radical cystectomy and bilateral pelvic lymphadenectomy for transitional cell carcinoma of the urinary bladder; they were compared with 172 who had organ-confined muscle-invasive disease (pT2). For the analyses we used univariable and multivariable Cox regression models of recurrence and cancer-specific survival, adjusted for age, tumour grade, lymphovascular invasion and the presence of lymph node metastases. RESULTS: In multivariable analyses, microscopic perivesical fat extension (pT3a) was not associated with higher recurrence (P = 0.3) or the mortality rate (P = 0.06) vs pT2 disease. Conversely, the presence of deep perivesical fat extension (pT3b) was associated with 1.8 times the rate of recurrence (P = 0.002) and with twice the rate of death (P = 0.001) vs pT2 disease. CONCLUSION: These findings imply that a detailed assessment of the cystectomy specimen for the presence of microscopic perivesical fat invasion might not be necessary, as the presence of pT3a disease has no strong effect on recurrence or mortality. Moreover, patients with pT3a disease might not require more aggressive therapy than their counterparts with pT2 disease. However, further validation of our data is required.

KW - Bladder cancer

KW - Cystectomy

KW - Recurrence

KW - Stage

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=38549153182&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38549153182&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2007.07213.x

DO - 10.1111/j.1464-410X.2007.07213.x

M3 - Article

C2 - 17850359

AN - SCOPUS:38549153182

VL - 101

SP - 450

EP - 454

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 4

ER -