Tumor Location May Predict Adverse Pathology and Survival Following Definitive Treatment for Bladder Cancer: A National Cohort Study.
Cystectomy
Epidemiology
Survival
Therapeutics
USA
Urinary bladder neoplasms
Journal
European urology oncology
ISSN: 2588-9311
Titre abrégé: Eur Urol Oncol
Pays: Netherlands
ID NLM: 101724904
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
03
06
2018
revised:
06
08
2018
accepted:
21
08
2018
entrez:
16
6
2019
pubmed:
16
6
2019
medline:
3
6
2020
Statut:
ppublish
Résumé
While urothelial carcinoma of the bladder is often considered a multifocal disease, the location of the dominant tumor may be prognostic. To determine the association between intravesical tumor location and both adverse pathological outcomes as well as overall survival. Patients in the National Cancer Database (2010-2015) with nonmetastatic urothelial carcinoma of the bladder who underwent primary treatment with radical cystectomy (RC; n=3464) or chemoradiotherapy (CRT; n=699). Multivariable logistic regressions assessed the prognostic ability of tumor location to predict adverse pathology at RC (nodal metastases [pN+] or advanced stage [pT3-4]). Cox regressions were used to determine the effect of tumor location on overall survival in patients treated with RC or CRT. Following RC, 822 (24%) patients were pN+ and 1551 (55%) were pT3-4. Trigonal tumors were most likely to have adverse pathology (31% pN+ and 59% pT3-4), while anterior wall tumors were the least (19% pN+ and 50% pT3-4). Relative to the anterior wall, trigone (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.12-2.43, p=0.012) and bladder neck (OR 1.79, 95% CI 1.11-2.90, p=0.018) tumors were associated with increased odds of pN+ and dome (OR 1.56, 95% CI 1.08-2.24, p=0.017) with pT3-4. In those patients treated with primary CRT, trigone involvement was associated with worse survival (HR 1.58, 95% CI 1.17-2.13, p=0.003). Limitations included unmeasured variables and a relatively few number of patients with certain tumor locations. Trigone and bladder neck tumors are associated with increased odds of nodal involvement, and dome with a higher tumor stage at RC. Patients with trigone involvement may have worse overall survival following CRT. Location of the tumor within the bladder may be associated with worse cancer staging at the time of the surgery and worse survival following chemoradiotherapy.
Sections du résumé
BACKGROUND
While urothelial carcinoma of the bladder is often considered a multifocal disease, the location of the dominant tumor may be prognostic.
OBJECTIVE
To determine the association between intravesical tumor location and both adverse pathological outcomes as well as overall survival.
DESIGN, SETTINGS, AND PARTICIPANTS
Patients in the National Cancer Database (2010-2015) with nonmetastatic urothelial carcinoma of the bladder who underwent primary treatment with radical cystectomy (RC; n=3464) or chemoradiotherapy (CRT; n=699).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Multivariable logistic regressions assessed the prognostic ability of tumor location to predict adverse pathology at RC (nodal metastases [pN+] or advanced stage [pT3-4]). Cox regressions were used to determine the effect of tumor location on overall survival in patients treated with RC or CRT.
RESULTS AND LIMITATIONS
Following RC, 822 (24%) patients were pN+ and 1551 (55%) were pT3-4. Trigonal tumors were most likely to have adverse pathology (31% pN+ and 59% pT3-4), while anterior wall tumors were the least (19% pN+ and 50% pT3-4). Relative to the anterior wall, trigone (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.12-2.43, p=0.012) and bladder neck (OR 1.79, 95% CI 1.11-2.90, p=0.018) tumors were associated with increased odds of pN+ and dome (OR 1.56, 95% CI 1.08-2.24, p=0.017) with pT3-4. In those patients treated with primary CRT, trigone involvement was associated with worse survival (HR 1.58, 95% CI 1.17-2.13, p=0.003). Limitations included unmeasured variables and a relatively few number of patients with certain tumor locations.
CONCLUSIONS
Trigone and bladder neck tumors are associated with increased odds of nodal involvement, and dome with a higher tumor stage at RC. Patients with trigone involvement may have worse overall survival following CRT.
PATIENT SUMMARY
Location of the tumor within the bladder may be associated with worse cancer staging at the time of the surgery and worse survival following chemoradiotherapy.
Identifiants
pubmed: 31200845
pii: S2588-9311(18)30137-8
doi: 10.1016/j.euo.2018.08.018
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
304-310Subventions
Organisme : BLRD VA
ID : I01 BX003692
Pays : United States
Informations de copyright
Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.