Cystectomie totale pour cancer urothélial : impact pronostique de l’atteinte ganglionnaire et des marges chirurgicales positives

Abstract

To assess the association of soft tissue surgical margins (STSM) and/or lymph node metatstasis (pN+) with characteristics and outcomes of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). We retrospectively collected the data of 242patients treated with RC and pelvic lymphadenectomy for UCB between January 2005and June 2009. Different parameters were studied: age, PSAt, pathological stage of cystectomy specimen (pT and pN), tumor grade, number (nb) of nodes (N) in lymphadenectomy, nb of metastatic nodes (nb N+), bigger diameter of N+, ganglionic density, nb of N with capsular ruptur, associated CIS, associated prostate cancer, follow-up, global and specific survival, date and etiology of death. Positive STSM were identified in 22patients (9.1%) and lymph node metastasis in 59 (24.4%). pN+ status was significantly associated with lower global (GS) and specific survival (SS) (P<0.003). So was it for patients with positive STSM R+ with actuarial 3-year GS and SS respectively of 5% and 25% versus 35% and 43.9% no STSM (P<0.001). Positive soft tissue surgical margin and/or lymph node metatstasis on cystectomy specimen is a strong predictor of GS and SS from urothelial carcinoma of the bladder. So it is for capsular rupture, ganglionic density greater or equal to 0.10and nb of N in lymphadenectomy less than 14for pN+ patients.