Risk factors associated with positive surgical margins’ location at radical cystectomy and their impact on bladder cancer survival

Claps F, Van De Kamp MW, Mayr R, Bostrom PJ, Boormans JL, Eckstein M, Mertens LS, Boeve ER, Neuzillet Y, Burger M, Pouessel D, Trombetta C, Wullich B, van der Kwast TH, Hartmann A, Allory Y, Lotan Y, Shariat SF, Zuiverloon TCM, Mir MC, van Rhijn BWG (2021)

Publication Type: Journal article

Publication year: 2021

Journal

World Journal of Urology Springer Verlag (Germany)

DOI: 10.1007/s00345-021-03776-5

Abstract

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.

Authors with CRIS profile

Markus Eckstein Institute of Pathology Bernd Wullich Lehrstuhl für Urologie Arndt Hartmann Lehrstuhl für Allgemeine Pathologie und Pathologische Anatomie

Involved external institutions

Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI / NKI-AVL) NL Netherlands (NL) Universität Regensburg DE Germany (DE) Franciscus Gasthuis & Vlietland NL Netherlands (NL) PSL Research University / Université de recherche Paris Sciences et Lettres FR France (FR) Valencia Oncology Institute Foundation / Fundación Instituto Valenciano de Oncología / Fundació Institut Valencià d’Oncologia (IVO) ES Spain (ES) University of Toronto CA Canada (CA) University of Texas Southwestern Medical Center (UT Southwestern) US United States (USA) (US) Università degli Studi di Trieste IT Italy (IT) Erasmus University Medical Center (MC) NL Netherlands (NL)

How to cite

APA:

Claps, F., Van De Kamp, M.W., Mayr, R., Bostrom, P.J., Boormans, J.L., Eckstein, M.,... van Rhijn, B.W.G. (2021). Risk factors associated with positive surgical margins’ location at radical cystectomy and their impact on bladder cancer survival. World Journal of Urology. https://doi.org/10.1007/s00345-021-03776-5

MLA:

Claps, Francesco, et al. "Risk factors associated with positive surgical margins’ location at radical cystectomy and their impact on bladder cancer survival." World Journal of Urology (2021).

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