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

Aged Cohort Studies Cystectomy / methods Female Humans Male Margins of Excision Middle Aged Risk Factors Survival Rate Urinary Bladder Neoplasms / mortality
Bladder Cancer Cystectomy Margin Soft tissue Ureter Urethra Urothelial carcinoma

Journal

World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716

Informations de publication

Date de publication:
Dec 2021
Historique:
received: 05 05 2021
accepted: 23 06 2021
pubmed: 2 7 2021
medline: 25 2 2022
entrez: 1 7 2021
Statut: ppublish

Résumé

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). 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. 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). 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.

Identifiants

DOI: 10.1007/s00345-021-03776-5 PMID: 34196758
pubmed: 34196758
doi: 10.1007/s00345-021-03776-5
pii: 10.1007/s00345-021-03776-5
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

4363-4371

Informations de copyright

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Références

Siegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer statistics, 2021. CA Cancer J Clin 71:7–33. https://doi.org/10.3322/caac.21654
doi: 10.3322/caac.21654 pubmed: 33433946
van Rhijn BWG, Burger M, Lotan Y et al (2009) Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol 56:430–442
doi: 10.1016/j.eururo.2009.06.028
Witjes JA, Bruins M, Cathomas R et al (2020) EAU guidelines on muscle-invasive and metastatic bladder cancer 2020. Eur Assoc Urol Guidel 71:462
doi: 10.1016/j.eururo.2016.06.020
Dotan ZA, Kavanagh K, Yossepowitch O et al (2007) Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. J Urol 178:2308–2313. https://doi.org/10.1016/j.juro.2007.08.023
doi: 10.1016/j.juro.2007.08.023 pubmed: 17936804
Osman Y, El-Tabey N, Abdel-Latif M et al (2007) The value of frozen-section analysis of ureteric margins on surgical decision-making in patients undergoing radical cystectomy for bladder cancer. BJU Int 99:81–84
doi: 10.1111/j.1464-410X.2006.06567.x
Novara G, Svatek RS, Karakiewicz PI et al (2010) Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4400 patients. J Urol 183:2165–2170. https://doi.org/10.1016/j.juro.2010.02.021
doi: 10.1016/j.juro.2010.02.021 pubmed: 20399473
Bruins HM, Veskimäe E, Hernández V et al (2020) The importance of hospital and surgeon volume as major determinants of morbidity and mortality after radical cystectomy for bladder cancer: a systematic review and recommendations by the European association of urology muscle-invasive and metastatic bladder cancer guideline panel. Eur Urol Oncol 3:131–144. https://doi.org/10.1016/j.euo.2019.11.005
doi: 10.1016/j.euo.2019.11.005 pubmed: 31866215
Millikan R, Dinney C, Swanson D et al (2001) Integrated therapy for locally advanced bladder cancer: final report of a randomized trial of cystectomy plus adjuvant M-VAC versus cystectomy with both preoperative and postoperative M-VAC. J Clin Oncol 19:4005–4013. https://doi.org/10.1200/JCO.2001.19.20.4005
doi: 10.1200/JCO.2001.19.20.4005 pubmed: 11600601
Picozzi S, Ricci C, Gaeta M et al (2012) Upper urinary tract recurrence following radical cystectomy for bladder cancer: a meta-analysis on 13,185 patients. J Urol 188:2046–2054
doi: 10.1016/j.juro.2012.08.017
Carando R, Shariat SF, Moschini M, D’Andrea D (2020) Ureteral and urethral recurrence after radical cystectomy: a systematic review. Curr Opin Urol 30:441–448. https://doi.org/10.1097/MOU.0000000000000752
doi: 10.1097/MOU.0000000000000752 pubmed: 32235282
Neuzillet Y, Soulie M, Larre S et al (2013) Positive surgical margins and their locations in specimens are adverse prognosis features after radical cystectomy in non-metastatic carcinoma invading bladder muscle: results from a nationwide case-control study. BJU Int 111:1253–1260. https://doi.org/10.1111/j.1464-410X.2012.11664.x
doi: 10.1111/j.1464-410X.2012.11664.x pubmed: 23331375
Hadjizacharia P, Stein JP, Cai J, Miranda G (2009) The impact of positive soft tissue surgical margins following radical cystectomy for high-grade, invasive bladder cancer. World J Urol 27:33–38. https://doi.org/10.1007/s00345-008-0345-1
doi: 10.1007/s00345-008-0345-1 pubmed: 19020884
Hautmann RE, Bolenz C, Volkmer B (2020) Unexpected early oncologic mortality after open radical cystectomy for bladder cancer: who is to be blamed? Urol Int 104:10–15. https://doi.org/10.1159/000503398
doi: 10.1159/000503398 pubmed: 31563906
Petrelli F, Coinu A, Cabiddu M et al (2014) Correlation of pathologic complete response with survival after neoadjuvant chemotherapy in bladder cancer treated with cystectomy: a meta-analysis. Eur Urol 65:350–357
doi: 10.1016/j.eururo.2013.06.049
Kim HS, Jeong CW, Kwak C et al (2016) Pathological T0 following cisplatin-based neoadjuvant chemotherapy for muscle-invasive bladder cancer: a network meta-analysis. Clin Cancer Res 22:1086–1094. https://doi.org/10.1158/1078-0432.CCR-15-1208
doi: 10.1158/1078-0432.CCR-15-1208 pubmed: 26503947
Kim H, Kim M, Kwak C et al (2014) Prognostic significance of lymphovascular invasion in radical cystectomy on patients with bladder cancer: a systematic review and meta-analysis. PLoS ONE 9:e89259
doi: 10.1371/journal.pone.0089259
Shariat SF, Svatek RS, Tilki D et al (2010) International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. BJU Int 105:1402–1412. https://doi.org/10.1111/j.1464-410X.2010.09217.x
doi: 10.1111/j.1464-410X.2010.09217.x pubmed: 20132195
Masson-Lecomte A, Francois T, Vordos D et al (2017) Predictive factors for final pathologic ureteral sections on 700 radical cystectomy specimens: implications for intraoperative frozen section decision-making. Urol Oncol Semin Orig Investig 35:659.e1-659.e6. https://doi.org/10.1016/j.urolonc.2017.06.053
doi: 10.1016/j.urolonc.2017.06.053
Moschini M, Gallina A, Freschi M et al (2016) Effect on postoperative survival of the status of distal ureteral margin: the necessity to achieve negative margins at the time of radical cystectomy. Urol Oncol Semin Orig Investig 34:59.e15-59.e22. https://doi.org/10.1016/j.urolonc.2015.09.001
doi: 10.1016/j.urolonc.2015.09.001
Kim HS, Moon KC, Jeong CW et al (2015) The clinical significance of intra-operative ureteral frozen section analysis at radical cystectomy for urothelial carcinoma of the bladder. World J Urol 33:359–365. https://doi.org/10.1007/s00345-014-1306-5
doi: 10.1007/s00345-014-1306-5 pubmed: 24825471
Satkunasivam R, Hu B, Metcalfe C et al (2016) Utility and significance of ureteric frozen section analysis during radical cystectomy. BJU Int 117:463–468. https://doi.org/10.1111/bju.13081
doi: 10.1111/bju.13081 pubmed: 25684323
Tran W, Serio AM, Raj GV et al (2008) Longitudinal risk of upper tract recurrence following radical cystectomy for urothelial cancer and the potential implications for long-term surveillance. J Urol 179:96–100. https://doi.org/10.1016/j.juro.2007.08.131
doi: 10.1016/j.juro.2007.08.131 pubmed: 17997449
McConkey DJ, Choi W (2018) Molecular subtypes of bladder cancer. Curr Oncol Rep 20:1
doi: 10.1007/s11912-018-0727-5
Zehnder P, Moltzahn F, Daneshmand S et al (2014) Outcome in patients with exclusive carcinoma in situ (CIS) after radical cystectomy. BJU Int 113:65–69. https://doi.org/10.1111/bju.12250
doi: 10.1111/bju.12250 pubmed: 23937628
Touma N, Izawa JI, Abdelhady M et al (2010) Ureteral frozen sections at the time of radical cystectomy: reliability and clinical implications. J Can Urol Assoc 4:28–32. https://doi.org/10.5489/cuaj.08107
doi: 10.5489/cuaj.08107
Tang J, Ranasinghe W, Cheng J et al (2019) Utility of routine intraoperative ureteral frozen section analysis at radical cystectomy: outcomes from a regional australian center. Curr Urol 12:70–73. https://doi.org/10.1159/000489422
doi: 10.1159/000489422 pubmed: 31114463 pmcid: 6504799
Sanderson KM, Cai J, Miranda G et al (2007) Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1069 patients with 10-year followup. J Urol 177:2088–2094. https://doi.org/10.1016/j.juro.2007.01.133
doi: 10.1016/j.juro.2007.01.133 pubmed: 17509294
Messer JC, Shariat SF, Dinney CP et al (2014) Female gender is associated with a worse survival after radical cystectomy for urothelial carcinoma of the bladder: a competing risk analysis. Urology 83:863–868. https://doi.org/10.1016/j.urology.2013.10.060
doi: 10.1016/j.urology.2013.10.060 pubmed: 24485993
Kates M, Ball MW, Chappidi MR et al (2016) Accuracy of urethral frozen section during radical cystectomy for bladder cancer. Urol Oncol Semin Orig Investig 34:532.e1-532.e6. https://doi.org/10.1016/j.urolonc.2016.06.014
doi: 10.1016/j.urolonc.2016.06.014
Osman Y, Mansour A, El-Tabey N et al (2012) Value of routine frozen section analysis of urethral margin in male patients undergoing radical cystectomy in predicting prostatic involvement. Int Urol Nephrol 44:1721–1725. https://doi.org/10.1007/s11255-012-0276-z
doi: 10.1007/s11255-012-0276-z pubmed: 22965379

Auteurs

Francesco Claps (F)

Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy.

Maaike W van de Kamp (MW)

Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.

Roman Mayr (R)

Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany.

Peter J Bostrom (PJ)

Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
Department of Urology, Turku University Hospital and University of Turku, Turku, Finland.

Joost L Boormans (JL)

Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.

Markus Eckstein (M)

Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany.

Laura S Mertens (LS)

Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.

Egbert R Boevé (ER)

Department of Urology, St Franciscus Hospital, Rotterdam, The Netherlands.

Yann Neuzillet (Y)

Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, 75005, Paris, France.

Maximilian Burger (M)

Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany.

Damien Pouessel (D)

Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, 75005, Paris, France.
Department of Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, 31000, Toulouse, France.

Carlo Trombetta (C)

Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy.

Bernd Wullich (B)

Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany.

Theo H van der Kwast (TH)

Department of Pathology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.

Arndt Hartmann (A)

Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany.

Yves Allory (Y)

Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, 75005, Paris, France.
Department of Pathology, Institut Curie, 75005, Paris, France.

Yair Lotan (Y)

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Shahrokh F Shariat (SF)

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.

Tahlita C M Zuiverloon (TCM)

Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.

M Carmen Mir (MC)

Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain.

Bas W G van Rhijn (BWG)

Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. b.v.rhijn@nki.nl.
Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany. b.v.rhijn@nki.nl.
Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada. b.v.rhijn@nki.nl.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Risk factors associated with positive surgical...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Risk factors associated with positive surgical...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Cystectomie › Risk factors associated with positive surgical...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Risk factors associated with positive surgical...
questionsmedicales.fr › États, signes et symptômes pathologiques › Résultats morphologiques et microscopiques › Marges d'exérèse › Risk factors associated with positive surgical...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Risk factors associated with positive surgical...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Risk factors associated with positive surgical...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Taux de survie › Risk factors associated with positive surgical...
questionsmedicales.fr › Maladies urogénitales › Maladies urologiques › Tumeurs urologiques › Tumeurs de la vessie urinaire › Risk factors associated with positive surgical...