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Risk factors associated with positive surgical margins' location at radical cystectomy and their impact on bladder cancer survival
F. Claps, MW. van de Kamp, R. Mayr, PJ. Bostrom, JL. Boormans, M. Eckstein, LS. Mertens, ER. Boevé, Y. Neuzillet, M. Burger, D. Pouessel, C. Trombetta, B. Wullich, TH. van der Kwast, A. Hartmann, Y. Allory, Y. Lotan, SF. Shariat, TCM. Zuiverloon,...
Jazyk angličtina Země Německo
Typ dokumentu časopisecké články, multicentrická studie
NLK
ProQuest Central
od 1997-02-01 do Před 1 rokem
Medline Complete (EBSCOhost)
od 2000-02-01 do Před 1 rokem
Health & Medicine (ProQuest)
od 1997-02-01 do Před 1 rokem
- MeSH
- cystektomie * metody MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- nádory močového měchýře mortalita patologie chirurgie MeSH
- resekční okraje * MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
PURPOSE: To evaluate the risk factors associated with positive surgical margins' (PSMs) location and their impact on disease-specific survival (DSS) in patients with bladder cancer (BCa) undergoing radical cystectomy (RC). METHODS: We analyzed a large multi-institutional cohort of patients treated with upfront RC for non-metastatic (cT1-4aN0M0) BCa. Multivariable binomial logistic regression analyses were used to assess the risk of PSMs at RC for each location after adjusting for clinicopathological covariates. The Kaplan-Meier method was used to estimate DSS stratified by margins' status and location. Log-rank statistics and Cox' regression models were used to determine significance. RESULTS: A total of 1058 patients were included and 108 (10.2%) patients had PSMs. PSMs were located at soft-tissue, ureter(s), and urethra in 57 (5.4%), 30 (2.8%) and 21 (2.0%) patients, respectively. At multivariable analysis, soft-tissue PSMs were independently associated with pathological stage T4 (pT4) (Odds ratio (OR) 6.20, p < 0.001) and lymph-node metastases (OR 1.86, p = 0.04). Concomitant carcinoma-in-situ (CIS) was an independent risk factor for ureteric PSMs (OR 6.31, p = 0.003). Finally, urethral PSMs were independently correlated with pT4-stage (OR 5.10, p = 0.01). The estimated 3-years DSS rates were 58.2%, 32.4%, 50.1%, and 40.3% for negative SMs, soft-tissue-, ureteric- and urethral PSMs, respectively (log-rank; p < 0.001). CONCLUSIONS: PSMs' location represents distinct risk factors' patterns. Concomitant CIS was associated with ureteric PSMs. Urethral and soft-tissue PSM showed worse DSS rates. Our results suggest that clinical decision-making paradigms on adjuvant treatment and surveillance might be adapted based on PSM and their location.
Department of Pathology Institut Curie 75005 Paris France
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Caritas St Josef Medical Center University of Regensburg Regensburg Germany
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Fundacion Instituto Valenciano Oncologia Valencia Spain
Department of Urology St Franciscus Hospital Rotterdam The Netherlands
Department of Urology Turku University Hospital and University of Turku Turku Finland
Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
Department of Urology Weill Cornell Medical College New York NY USA
Institut Curie CNRS UMR144 Molecular Oncology Team PSL Research University 75005 Paris France
Citace poskytuje Crossref.org
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- $a Claps, Francesco $u Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands $u Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy
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- $a Risk factors associated with positive surgical margins' location at radical cystectomy and their impact on bladder cancer survival / $c F. Claps, MW. van de Kamp, R. Mayr, PJ. Bostrom, JL. Boormans, M. Eckstein, LS. Mertens, ER. Boevé, Y. Neuzillet, M. Burger, D. Pouessel, C. Trombetta, B. Wullich, TH. van der Kwast, A. Hartmann, Y. Allory, Y. Lotan, SF. Shariat, TCM. Zuiverloon, MC. Mir, BWG. van Rhijn
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- $a PURPOSE: To evaluate the risk factors associated with positive surgical margins' (PSMs) location and their impact on disease-specific survival (DSS) in patients with bladder cancer (BCa) undergoing radical cystectomy (RC). METHODS: We analyzed a large multi-institutional cohort of patients treated with upfront RC for non-metastatic (cT1-4aN0M0) BCa. Multivariable binomial logistic regression analyses were used to assess the risk of PSMs at RC for each location after adjusting for clinicopathological covariates. The Kaplan-Meier method was used to estimate DSS stratified by margins' status and location. Log-rank statistics and Cox' regression models were used to determine significance. RESULTS: A total of 1058 patients were included and 108 (10.2%) patients had PSMs. PSMs were located at soft-tissue, ureter(s), and urethra in 57 (5.4%), 30 (2.8%) and 21 (2.0%) patients, respectively. At multivariable analysis, soft-tissue PSMs were independently associated with pathological stage T4 (pT4) (Odds ratio (OR) 6.20, p < 0.001) and lymph-node metastases (OR 1.86, p = 0.04). Concomitant carcinoma-in-situ (CIS) was an independent risk factor for ureteric PSMs (OR 6.31, p = 0.003). Finally, urethral PSMs were independently correlated with pT4-stage (OR 5.10, p = 0.01). The estimated 3-years DSS rates were 58.2%, 32.4%, 50.1%, and 40.3% for negative SMs, soft-tissue-, ureteric- and urethral PSMs, respectively (log-rank; p < 0.001). CONCLUSIONS: PSMs' location represents distinct risk factors' patterns. Concomitant CIS was associated with ureteric PSMs. Urethral and soft-tissue PSM showed worse DSS rates. Our results suggest that clinical decision-making paradigms on adjuvant treatment and surveillance might be adapted based on PSM and their location.
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