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World Journal of Urology

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01-02-2009 | Topic Paper

The impact of positive soft tissue surgical margins following radical cystectomy for high-grade, invasive bladder cancer

Authors: Pantelis Hadjizacharia, John P. Stein, Jie Cai, Gus Miranda

Published in: World Journal of Urology | Issue 1/2009

Abstract

Introduction

We evaluate the incidence and risk factors associated with positive soft tissue surgical margins (STSM) and determine the association with various surgical and pathological characteristics and clinical outcomes in patients undergoing radical cystectomy (RC) for bladder cancer.

Patients and methods

From November 1971 to December 2005, 1,591 patients with primary transitional cell carcinoma (TCC) of the bladder underwent RC, with an extended bilateral pelvic lymphadenectomy and urinary diversion. A positive STSM was defined as tumor identified at the inked perivesical soft tissue surrounding the cystectomy specimen. Data were analyzed according to various clinical and pathologic variables, and survival analysis was performed.

Results

A total of 18 patients (1%) demonstrated pathologic evidence of a positive STSM following RC. Positive STSM were significantly associated with lymphovascular invasion, advanced pathologic stage, lymph node involvement, extent of nodal involvement and lymph node density. No patient with an organ-confined primary bladder tumor had a positive STSM, while 3% with extravesical tumor extension demonstrated a positive STSM. Recurrence-free and overall survival at 5 and 10 years for patients with a positive STSM was 29 and 22%, and 29 and 11%, respectively (p < 0.001). A positive STSM increased the risk of recurrence by threefold and the overall risk of death by 2.6 times. Only nine patients (1%) without evidence of nodal involvement had a positive STSM with a worse survival compared to those same pathologic subgroup and negative STSM. Nine patients (2%) with lymph node tumor involvement had positive STSM and also demonstrated significantly worse survival.

Conclusion

Although a positive STSM was present in only 1% of patients undergoing a RC for TCC of the bladder, it was found to be an independent risk factor for advanced disease, lymph node involvement and tumor progression with worse survival. A dedicated effort should be made to avoid a positive STSM at the time of RC.

Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long term results in 1,054 patients. J Clin Oncol 19:666PubMed

Madersbacher S, Hochreiter W, Burkhard F, Thalmann GN, Danuser H, Markwalder R et al (2003) Radical cystectomy for bladder cancer today—a homogeneous series without neoadjuvant therapy. J Clin Oncol 21:690. doi:10.1200/JCO.2003.05.101 PubMedCrossRef

Stein JP, Skinner DG (2003) Results with radical cystectomy for treating bladder cancer: a ‘reference standard’ for high-grade, invasive bladder cancer. BJU Int 92:12. doi:10.1046/j.1464-410X.2003.04274.x PubMedCrossRef

Hautmann RE, Gschwend JE, de Petriconi RC, Kron M, Volkmer BG (2006) Cystectomy for transitional cell carcinoma of the bladder: results of a surgery only series in the neobladder era. J Urol 176:486. doi:10.1016/j.juro.2006.03.038 PubMedCrossRef

Herr HW, Faulkner JR, Grossman B, Natale RB, deVere White R, Sarosdy MF, Crawford ED (2004) Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol 22:2781. doi:10.1200/JCO.2004.11.024 PubMedCrossRef

Stein JP (2006) Improving outcomes with radical cystectomy for high-grade invasive bladder cancer. World J Urol 24:509. doi:10.1007/s00345-006-0111-1 PubMedCrossRef

Stein JP, Skinner DG (2006) Radical cystectomy for invasive bladder cancer: long-term results of a standard procedure. World J Urol 24:296. doi:10.1007/s00345-006-0061-7 PubMedCrossRef

Dotan ZA, Kavanagh K, Yossepowitch O, Kaag M, Olgac S, Donat M, Herr HW (2007) Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. J Urol 178:2308. doi:10.1016/j.juro.2007.08.023 PubMedCrossRef

Bergkvist A, Ljungqvist A, Moberger G (1965) Classification of bladder tumors based on cellular pattern. Preliminary report of a clinical-pathological study of 300 cases with a minimum follow-up of eight years. Acta Chir Scand 130:371PubMed

10.

Fleming ID, Cooper JS, Hensen DE, Hutter RVP, Kennedy BJ, Murphy GP et al (1997) AJCC cancer staging manual, 5th edn. Lippincott, Philadelphia, pp 241–243

11.

Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457. doi:10.2307/2281868 CrossRef

12.

Miller RG (1981) Survival analysis. Wiley, New York, pp 114–118

13.

Breslow N (1988) Comparison of survival curves. Oxford University Press, Oxford, pp 398–403

14.

Skinner EC, Stein JP, Skinner DG (2007) Surgical benchmarks for the treatment of invasive bladder cancer. Urol Oncol 25:66. doi:10.1016/j.urolonc.2006.05.010 PubMed

15.

Cheng L, Weaver AL, Leibovich BC, Ramna ni DM, Neumann RM, Scherer BG et al (2000) Predicting the survival of bladder carcinoma patients treated with radical cystectomy. Cancer 88:2326. doi:10.1002/(SICI)1097-0142(20000515)88:10<2326::AID-CNCR17>3.0.CO;2-TPubMedCrossRef

16.

Herr H, Lee C, Chang S, Lerner S (2004) Standardization of radical cystectomy and pelvic lymph node dissection for bladder cancer: a collaborative group report. J Urol 171:1823. doi:10.1097/01.ju.0000120289.78049.0e PubMedCrossRef

17.

Herr HW, Faulkner JR, Grossman HB, Crawford ED (2004) Pathologic evaluation of radical cystectomy specimens: a cooperative group report. Cancer 100:2470. doi:10.1002/cncr.20282 PubMedCrossRef

18.

Sternberg CN, Donat SM, Bellmunt J, Millikan RE, Stadler W, De Mulder P et al (2007) Chemotherapy for bladder cancer: treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer. Urology 69:62. doi:10.1016/j.urology.2006.10.041 PubMedCrossRef

19.

Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL et al (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349:859. doi:10.1056/NEJMoa022148 PubMedCrossRef

Title: The impact of positive soft tissue surgical margins following radical cystectomy for high-grade, invasive bladder cancer
Authors: Pantelis Hadjizacharia
John P. Stein
Jie Cai
Gus Miranda
Publication date: 01-02-2009
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 1/2009
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-008-0345-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The impact of positive soft tissue surgical margins following radical cystectomy for high-grade, invasive bladder cancer

Abstract

Introduction

Patients and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

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