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• W2113993502 abstract "No AccessJournal of UrologyAdult Urology1 Jun 2010Soft 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 Schoenberg, Bjoern G. Volkmer, Arthur I. Sagalowsky, and Shahrokh F. Shariat Giacomo NovaraGiacomo Novara University of Padua, Padua, Italy More articles by this author , Robert S. SvatekRobert S. Svatek University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz University of Montréal, Montréal, Québec, Canada More articles by this author , Eila SkinnerEila Skinner University of Southern California, Los Angeles, California More articles by this author , Vincenzo FicarraVincenzo Ficarra University of Padua, Padua, Italy More articles by this author , Yves FradetYves Fradet Laval University, Québec City, Québec, Canada More articles by this author , Yair LotanYair Lotan University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author , Hendrik IsbarnHendrik Isbarn University of Montréal, Montréal, Québec, Canada More articles by this author , Umberto CapitanioUmberto Capitanio University of Montréal, Montréal, Québec, Canada More articles by this author , Patrick J. BastianPatrick J. Bastian Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany Universität Bonn, Bonn, Germany More articles by this author , Wassim KassoufWassim Kassouf McGill University Health Centre, Montréal, Québec, Canada More articles by this author , Hans-Martin FritscheHans-Martin Fritsche University of Regensburg, Regensburg, Germany More articles by this author , Jonathan I. IzawaJonathan I. Izawa University of Western Ontario, London, Ontario, Canada More articles by this author , Derya TilkiDerya Tilki Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany More articles by this author , Colin P. DinneyColin P. Dinney University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author , Seth P. LernerSeth P. Lerner Baylor College of Medicine, Houston, Texas More articles by this author , Mark SchoenbergMark Schoenberg Johns Hopkins University, Baltimore, Maryland More articles by this author , Bjoern G. VolkmerBjoern G. Volkmer University of Ulm, Ulm, Germany More articles by this author , Arthur I. SagalowskyArthur I. Sagalowsky University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author , and Shahrokh F. ShariatShahrokh F. Shariat University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.021AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. References 1 : Cancer Statistics, 2008. CA Cancer J Clin2009; 59: 225. Google Scholar 2 : Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol2007; 18: 581. Google Scholar 3 : The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol2009; 55: 815. Google Scholar 4 : Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol2001; 19: 666. Google Scholar 5 : Radical cystectomy for bladder cancer today–a homogeneous series without neoadjuvant therapy. J Clin Oncol2003; 21: 690. Google Scholar 6 : Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer. J Clin Oncol2006; 24: 3967. Google Scholar 7 : Nomogram for predicting disease recurrence after radical cystectomy for transitional cell carcinoma of the bladder. J Urol2006; 176: 1354. Link, Google Scholar 8 : Nomograms provide improved accuracy for predicting survival after radical cystectomy. Clin Cancer Res2006; 12: 6663. Google Scholar 9 : Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: analysis of pooled data from MDACC and MSKCC. J Clin Oncol2008; 26: 121. Google Scholar 10 : Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. J Urol2007; 178: 2308. Link, Google Scholar 11 : The impact of positive soft tissue surgical margins following radical cystectomy for high-grade, invasive bladder cancer. World J Urol2009; 27: 33. Google Scholar 12 : The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder: Bladder Consensus Conference Committee. Am J Surg Pathol1998; 22: 1435. Google Scholar 13 : TNM Classification of Malignant Tumors. New York: Wiley-Liss2002. Google Scholar 14 : Pathologic evaluation of radical cystectomy specimens: a cooperative group report. Cancer2004; 100: 2470. Google Scholar 15 : Standardization of radical cystectomy and pelvic lymph node dissection for bladder cancer: a collaborative group report. J Urol2004; 171: 1823. Link, Google Scholar © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byElsayed A, Gibson S, Jing Z, Wijburg C, Wagner A, Mottrie A, Dasgupta P, Peabody J, Hussein A and Guru K (2020) Rates and Patterns of Recurrences and Survival Outcomes after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy ConsortiumJournal of Urology, VOL. 205, NO. 2, (407-413), Online publication date: 1-Feb-2021.Almassi N, Cha E, Vertosick E, Huang C, Wong N, Dason S, McPherson V, Dean L, Benfante N, Sjoberg D, Rosenberg J, Bajorin D, Herr H, Dalbagni G and Bochner B (2020) Trends in Management and Outcomes among Patients with Urothelial Carcinoma Undergoing Radical Cystectomy from 1995 to 2015: The Memorial Sloan Kettering ExperienceJournal of Urology, VOL. 204, NO. 4, (677-684), Online publication date: 1-Oct-2020.Hussein A, Elsayed A, Aldhaam N, Jing Z, Osei J, Kaouk J, Redorta J, Menon M, Peabody J, Dasgupta P, Khan M, Mottrie A, Stöckle M, Hemal A, Richstone L, Hosseini A, Wiklund P, Schanne F, Kim E, Ho Rha K and Guru K (2019) Ten-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy ConsortiumJournal of Urology, VOL. 202, NO. 5, (927-935), Online publication date: 1-Nov-2019.Khanna A, Saarela O, Lawson K, Finelli A, Haber G, Lee B and Abouassaly R (2019) Hospital Quality Metrics for Radical Cystectomy: Disease Specific and Correlated to Mortality OutcomesJournal of Urology, VOL. 202, NO. 3, (490-497), Online publication date: 1-Sep-2019.Chang S (2019) Re: Predicting Local Failure after Radical Cystectomy in Patients with Bladder Cancer: Implications for the Selection of Candidates at Adjuvant Radiation TherapyJournal of Urology, VOL. 201, NO. 5, (857-857), Online publication date: 1-May-2019.Kates M, Sopko N, Han M, Partin A and Epstein J (2015) Importance of Reporting the Gleason Score at the Positive Surgical Margin Site: Analysis of 4,082 Consecutive Radical Prostatectomy CasesJournal of Urology, VOL. 195, NO. 2, (337-342), Online publication date: 1-Feb-2016.Klatte T, Seitz C, Rink M, Rouprêt M, Xylinas E, Karakiewicz P, Susani M and Shariat S (2015) ERCC1 as a Prognostic and Predictive Biomarker for Urothelial Carcinoma of the Bladder following Radical CystectomyJournal of Urology, VOL. 194, NO. 5, (1456-1462), Online publication date: 1-Nov-2015.Luchey A, Lin H, Yue B, Agarwal G, Gilbert S, Lockhart J, Poch M, Pow-Sang J, Spiess P and Sexton W (2015) Implications of Definitive Prostate Cancer Therapy on Soft Tissue Margins and Survival in Patients Undergoing Radical Cystectomy for Bladder Urothelial CancerJournal of Urology, VOL. 194, NO. 5, (1220-1225), Online publication date: 1-Nov-2015.da Silva R, Xylinas E, Kluth L, Crivelli J, Chrystal J, Chade D, Guglielmetti G, Pycha A, Lotan Y, Karakiewicz P, Sun M, Fajkovic H, Zerbib M, Scherr D and Shariat S (2013) Impact of Statin Use on Oncologic Outcomes in Patients with Urothelial Carcinoma of the Bladder Treated with Radical CystectomyJournal of Urology, VOL. 190, NO. 2, (487-492), Online publication date: 1-Aug-2013.Abaza R, Dangle P, Gong M, Bahnson R and Pohar K (2012) Quality of Lymphadenectomy is Equivalent With Robotic and Open Cystectomy Using an Extended TemplateJournal of Urology, VOL. 187, NO. 4, (1200-1205), Online publication date: 1-Apr-2012. Volume 183Issue 6June 2010Page: 2165-2170 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordstransitional cellprognosiscarcinomacystectomysurvivalurinary bladder neoplasmsMetricsAuthor Information Giacomo Novara University of Padua, Padua, Italy More articles by this author Robert S. Svatek University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author Pierre I. Karakiewicz University of Montréal, Montréal, Québec, Canada More articles by this author Eila Skinner University of Southern California, Los Angeles, California More articles by this author Vincenzo Ficarra University of Padua, Padua, Italy More articles by this author Yves Fradet Laval University, Québec City, Québec, Canada More articles by this author Yair Lotan University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Hendrik Isbarn University of Montréal, Montréal, Québec, Canada More articles by this author Umberto Capitanio University of Montréal, Montréal, Québec, Canada More articles by this author Patrick J. Bastian Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany Universität Bonn, Bonn, Germany More articles by this author Wassim Kassouf McGill University Health Centre, Montréal, Québec, Canada More articles by this author Hans-Martin Fritsche University of Regensburg, Regensburg, Germany More articles by this author Jonathan I. Izawa University of Western Ontario, London, Ontario, Canada More articles by this author Derya Tilki Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany More articles by this author Colin P. Dinney University of Texas M.D. Anderson Cancer Center, Houston, Texas More articles by this author Seth P. Lerner Baylor College of Medicine, Houston, Texas More articles by this author Mark Schoenberg Johns Hopkins University, Baltimore, Maryland More articles by this author Bjoern G. Volkmer University of Ulm, Ulm, Germany More articles by this author Arthur I. Sagalowsky University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Shahrokh F. Shariat University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W2113993502 title "Soft Tissue Surgical Margin Status is a Powerful Predictor of Outcomes After Radical Cystectomy: A Multicenter Study of More Than 4,400 Patients" @default.
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