Soft Tissue Surgical Margin Status is a Powerful Predictor of Outcomes After Radical Cystectomy: A Multicenter Study of More Than 4,400 Patients

Giacomo Novara, Robert S. Svatek, Pierre I. Karakiewicz, Eila Skinner, Vincenzo Ficarra, Yves Fradet, Yair Lotan, Hendrik Isbarn, Umberto Capitanio, Patrick J. Bastian, Wassim Kassouf, Hans Martin Fritsche, Jonathan I. Izawa, Derya Tilki, Colin P. Dinney, Seth P. Lerner, Mark P. Schoenberg, Bjoern G. Volkmer, Arthur I. Sagalowsky, Shahrokh F. Shariat

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)2165-2170
Number of pages6
JournalJournal of Urology
Volume183
Issue number6
DOIs
StatePublished - Jun 2010
Externally publishedYes

Fingerprint

Cystectomy
Multicenter Studies
Recurrence
Margins of Excision
Neoplasms
Urinary Bladder
Carcinoma
Adjuvant Chemotherapy
Lymph Node Excision
Canada
Lymph Nodes
Neoplasm Metastasis

Keywords

  • carcinoma
  • cystectomy
  • prognosis
  • survival
  • transitional cell
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Soft Tissue Surgical Margin Status is a Powerful Predictor of Outcomes After Radical Cystectomy : A Multicenter Study of More Than 4,400 Patients. / Novara, Giacomo; Svatek, Robert S.; Karakiewicz, Pierre I.; Skinner, Eila; Ficarra, Vincenzo; Fradet, Yves; Lotan, Yair; Isbarn, Hendrik; Capitanio, Umberto; Bastian, Patrick J.; Kassouf, Wassim; Fritsche, Hans Martin; Izawa, Jonathan I.; Tilki, Derya; Dinney, Colin P.; Lerner, Seth P.; Schoenberg, Mark P.; Volkmer, Bjoern G.; Sagalowsky, Arthur I.; Shariat, Shahrokh F.

In: Journal of Urology, Vol. 183, No. 6, 06.2010, p. 2165-2170.

Research output: Contribution to journalArticle

Novara, G, Svatek, RS, Karakiewicz, PI, Skinner, E, Ficarra, V, Fradet, Y, Lotan, Y, Isbarn, H, Capitanio, U, Bastian, PJ, Kassouf, W, Fritsche, HM, Izawa, JI, Tilki, D, Dinney, CP, Lerner, SP, Schoenberg, MP, Volkmer, BG, Sagalowsky, AI & Shariat, SF 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, vol. 183, no. 6, pp. 2165-2170. https://doi.org/10.1016/j.juro.2010.02.021
Novara, Giacomo ; Svatek, Robert S. ; Karakiewicz, Pierre I. ; Skinner, Eila ; Ficarra, Vincenzo ; Fradet, Yves ; Lotan, Yair ; Isbarn, Hendrik ; Capitanio, Umberto ; Bastian, Patrick J. ; Kassouf, Wassim ; Fritsche, Hans Martin ; Izawa, Jonathan I. ; Tilki, Derya ; Dinney, Colin P. ; Lerner, Seth P. ; Schoenberg, Mark P. ; Volkmer, Bjoern G. ; Sagalowsky, Arthur I. ; Shariat, Shahrokh F. / Soft Tissue Surgical Margin Status is a Powerful Predictor of Outcomes After Radical Cystectomy : A Multicenter Study of More Than 4,400 Patients. In: Journal of Urology. 2010 ; Vol. 183, No. 6. pp. 2165-2170.
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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.",
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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 P.

AU - Volkmer, Bjoern G.

AU - Sagalowsky, Arthur I.

AU - Shariat, Shahrokh F.

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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

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