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

• DOI: 10.1016/j.juro.2010.02.021
• Publication Date: 2010-04-18T14:48:37Z
• Authors: Giacomo Novara; Robert S. Svatek; Pierre I. Karakie...; 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; Shahrokh F. Shariat
• Keywords: Male; Carcinoma, Transitional Cell; radical cystectomy; muscle invasive bladder cancer; Soft Tissue Neoplasms; Cystectomy; 3. Good health; carcinoma; cystectomy; prognosis; survival; transitional cell; urinary bladder neoplasms; Aged; Carcinoma, Transitional Cell; Female; Humans; Male; Neoplasm Invasiveness; Retrospective Studies; Soft Tissue Neoplasms; Urinary Bladder Neoplasms; Cystectomy; 03 medical and health sciences; 0302 clinical medicine; Urinary Bladder Neoplasms; Humans; Female; Neoplasm Invasiveness; Aged; Retrospective Studies

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.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.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.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.