Positive Soft Tissue Surgical Margins Research Articles

Identifying the driver histology responsible for the inferior clinicopathologic features associated with plasmacytoid bladder cancer.

e16505 Background: Plasmacytoid urothelial cancer (PUC) is notorious for its spread along fascial planes which reportedly induces worse clinicopathologic. Usually, PUC is present with Conventional UC (CUC); however, the precise assessment of the PUC component in key pathological findings and its effect on clinical behavior has not been delineated. Methods: We performed a retrospective review of patients with PUC who underwent cystectomy at Moffitt Cancer Center between 2012-2022. Repeat histological review of all specimens by specialty trained genitourinary pathologists was performed (AV, ED). Positive margins and lymph nodes were examined and classified by histological subtype. We calculate the proportion of tissue sections with peri-vesical fat invasion in tumor tissue sections submitted from cystectomy specimen in pT3 cases as the microscopic surrogate for macroscopic pT3 sub staging (termed Peri-vesical Fat Invasion Ratio, PFIr). Pearson’s correlation coefficient was used to measure strength and direction of relationship between variables. Kaplan-Meier (KM) analysis was performed for overall survival (OS). Results: Population consists of 44 patients undergoing cystectomy for PUC. Median age was 70 (IQR 63-75) years old with 82% being male. Majority of patients (52.5%) had ≥cT3 disease and 55% received neoadjuvant chemotherapy (NAC). Median percent of plasmacytoid histology was 20% (IQR 5-80%) with 6 (14%), 2 (5%), 5 (11%), 16 (36%), and 15 (34%) being pT0, pT1, pT2, pT3, and pT4, respectively. Of the patients with pT3 disease, 6 were pT3a with a median 78% (IQR 39-82%) PFIr while 10 were pT3b with an associated median PFIr of 56% (42-63%). In total, 14 (32%) patients had positive soft tissue surgical margin, with 11 (79%) being of PUC histology and ten patients with a positive ureteral margin, 80% of which consisted of PUC histology. A total of 97 lymph nodes removed were positive for malignancy with 51.5% demonstrating PUC and 48.5% CUC histology. Univariate analysis confirmed an increasing percentage of PUC histology portended a worse OS (HR 3.27, 95% CI 1.22-8.73, p = 0.018). Additionally, we calculated Pearson’s correlation coefficient for percent of plasmacytoid histology with pathologic tumor stage (r = 0.468, p = < 0.001), soft tissue margin (r = 0.283, p = 0.031), and lymph node density (r = 0.264, p = 0.138). Finally, KM analysis for histologic subtype (PUC vs CUC) at positive margin or positive lymph did not affect OS (p > 0.05), likely a product of our small numbers. Conclusions: The plasmacytoid component of bladder cancer is more likely to spread through direct extension along tissue planes to the surrounding soft tissue and ureters rather than through lymphatics. Also, given the discohesive nature of PUC histology, gross peri-vesical extension may be an inadequate method of sub-stratifying stage pT3 disease.

PD29-09 COMPARISON OF SURVIVAL OUTCOMES AMONG PATIENTS WITH POSITIVE SOFT TISSUE MARGINS VERSUS POSITIVE NON-SOFT TISSUE MARGINS ALONE FOLLOWING RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023PD29-09 COMPARISON OF SURVIVAL OUTCOMES AMONG PATIENTS WITH POSITIVE SOFT TISSUE MARGINS VERSUS POSITIVE NON-SOFT TISSUE MARGINS ALONE FOLLOWING RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER Julian Rowe, Andrew Gabrielson, Una Choi, Sunil Patel, Trinity Bivalacqua, Max Kates, and Noah Hahn Julian RoweJulian Rowe More articles by this author , Andrew GabrielsonAndrew Gabrielson More articles by this author , Una ChoiUna Choi More articles by this author , Sunil PatelSunil Patel More articles by this author , Trinity BivalacquaTrinity Bivalacqua More articles by this author , Max KatesMax Kates More articles by this author , and Noah HahnNoah Hahn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003315.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) is a mainstay treatment for patients with muscle-invasive bladder cancer. While positive soft tissue surgical margins (STSM) portend worse outcomes compared to negative margins, outcomes from positive STSM vs positive non-STSM alone remain understudied. We compare outcomes among patients with positive STSM, positive non-STSM alone, and negative margins following RC. METHODS: A retrospective cohort study was conducted using a single-institution RC registry from 2000-2018. Inclusion criteria included age>18, histologically confirmed urothelial carcinoma, RC with curative intent, and available pathology report. We defined 3 patient groups: 1) positive STSM (adjacent muscle or pelvic organs) ±positive non-STSM, 2) positive non-STSM (urethra or ureter) alone, 3) negative margins. Kaplan-Meier (KM) analysis with log-rank test was used to compare recurrence-free survival (RFS) and overall survival (OS). RESULTS: A total of 236 patients with positive margins and 1,138 patients with negative margins after RC were included. Of those with positive margins, 83 (35.2%) had positive STSM and 153 (64.9%) had positive non-STSM alone. There was no difference in age, adjuvant chemotherapy use, pN+rate between those with positive STSM compared to non-STSM. There was significantly higher variant histology (25.9% vs 8.4%, p<0.001) as well as NAC utilization (43.2% vs 25.2%, p=0.009) in positive STSM compared to non-STSM. Patients with positive STSMs demonstrated significantly worse median RFS (10.5 months vs 35.1 months, p=0.009) and OS (13.7 vs 27.8 months, p=0.013) compared to those with positive non-STSMs alone. Patients with positive non-STSM alone had significantly worse median RFS (35.1 vs 150.8 months, p<0.001) and OS (27.8 vs 87.7 months, p<0.001) compared to those with negative margins. KM analysis demonstrated distinct RFS and OS outcomes between the 3 groups (Figure 1). CONCLUSIONS: Positive STSM were associated with worse RFS and OS compared to positive non-STSM however positive non-STSM alone represents a distinct clinical entity from those with negative margins, and these data can inform patient counseling. This study was limited by differential rates of variant histology and NAC use. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e827 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julian Rowe More articles by this author Andrew Gabrielson More articles by this author Una Choi More articles by this author Sunil Patel More articles by this author Trinity Bivalacqua More articles by this author Max Kates More articles by this author Noah Hahn More articles by this author Expand All Advertisement PDF downloadLoading ...

PD09-09 SURVIVAL BENEFITS OF ADJUVANT CHEMOTHERAPY FOR POSITIVE SOFT TISSUE SURGICAL MARGINS FOLLOWING RADICAL CYSTECTOMY IN BLADDER CANCER WITH EXTRAVESICAL EXTENSION

You have accessJournal of UrologyCME1 Apr 2023PD09-09 SURVIVAL BENEFITS OF ADJUVANT CHEMOTHERAPY FOR POSITIVE SOFT TISSUE SURGICAL MARGINS FOLLOWING RADICAL CYSTECTOMY IN BLADDER CANCER WITH EXTRAVESICAL EXTENSION Prithvi Murthy, Shreyas Naidu, Facundo Davaro, Philippe Spiess, Logan Zemp, Michael Poch, Rohit Jain, Aram Vosoughi, Alice Yu, Wade Sexton, Scott Gilbert, and Roger Li Prithvi MurthyPrithvi Murthy More articles by this author , Shreyas NaiduShreyas Naidu More articles by this author , Facundo DavaroFacundo Davaro More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Logan ZempLogan Zemp More articles by this author , Michael PochMichael Poch More articles by this author , Rohit JainRohit Jain More articles by this author , Aram VosoughiAram Vosoughi More articles by this author , Alice YuAlice Yu More articles by this author , Wade SextonWade Sexton More articles by this author , Scott GilbertScott Gilbert More articles by this author , and Roger LiRoger Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003240.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Locally advanced muscle invasive bladder cancer is an aggressive disease entity that requires multimodal therapy. However, the benefits of adjuvant chemotherapy (AC) in patients with a positive soft-tissue surgical margin (STSM) are relatively unknown. We sought to define survival benefits in this cohort in our institutional bladder cancer database. METHODS: We performed a retrospective review of all patients undergoing radical cystectomy for urothelial carcinoma of the bladder at Moffitt Cancer Center from 2004-2020 with gross extravesical (≥pT3b) disease irrespective of neoadjuvant chemotherapy (NAC) use or pathologic lymph node metastases. Overall survival estimates were obtained using the Kaplan-Meier method with log-rank test and the Cox-proportional hazards model was used to identify predictors of overall survival. AC was defined by any chemotherapy use within 90 days of cystectomy, regardless of STSM status. RESULTS: 441 patients with pT3b disease or worse and adjuvant chemotherapy data were identified. Baseline clinicodemographic information are listed in Table 1. Positive STSM (HR 1.90, 1.42-2.53, 95% CI, p<0.001) and AC use (HR 0.63, 0.47-0.84, 95% CI, p=0.002) were significantly associated with poorer overall survival when adjusted for pathologic T-stage, N-stage, performance status and NAC use. On subgroup analysis, as shown in Figure 1, the use of AC in patients with a positive STSM improved median OS from 6 months [4-8, 95% CI] to 16 months [11-53, 95% CI] (p<0.01). In patients with a negative soft-tissue surgical margin, the median survival with AC was 22 months [17-37, 95% CI] compared to 16 months [14-20, 95% CI] without (p=0.14). ECOG performance status, NAC use, rates of pathologic nodal involvement, and LVI did not differ by AC use in the entire cohort or based on STSM status. CONCLUSIONS: Adjuvant chemotherapy may particularly benefit patients with positive STSM following radical cystectomy for gross extravesical disease. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e243 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Prithvi Murthy More articles by this author Shreyas Naidu More articles by this author Facundo Davaro More articles by this author Philippe Spiess More articles by this author Logan Zemp More articles by this author Michael Poch More articles by this author Rohit Jain More articles by this author Aram Vosoughi More articles by this author Alice Yu More articles by this author Wade Sexton More articles by this author Scott Gilbert More articles by this author Roger Li More articles by this author Expand All Advertisement PDF downloadLoading ...

MP46-11 LONG-TERM ONCOLOGIC OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY: UPDATE SERIES FROM A HIGH-VOLUME ROBOTIC CENTER BEYOND 10 YEARS OF FOLLOW-UP

You have accessJournal of UrologyCME1 Apr 2023MP46-11 LONG-TERM ONCOLOGIC OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY: UPDATE SERIES FROM A HIGH-VOLUME ROBOTIC CENTER BEYOND 10 YEARS OF FOLLOW-UP Angelo Mottaran, Carlo Bravi, Adele Piro, Luca Sarchi, Marco Paciotti, Maria Peraire Lores, Eleonora Balestrazzi, Luigi Nocera, Federico Piramide, Ruben De Groote, Frederiek D'hondt, Alberto Briganti, Francesco Montorsi, and Alexandre Mottrie Angelo MottaranAngelo Mottaran More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Adele PiroAdele Piro More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Federico PiramideFederico Piramide More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Frederiek D'hondtFrederiek D'hondt More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) for non-metastatic bladder cancer (BCa) are limited. We here assessed long-term oncologic outcomes of patients receiving robotic radical cystectomy at a high-volume European Institution. METHODS: We analyzed data of 107 patients treated with RARC between 2003 and 2012 at a high-volume robotic center (OLV Hospital, Aalst, Belgium). All surgeries were performed by two high-volume surgeons. Clinical, pathologic, and survival data at the latest follow-up were collected. Clinical recurrence (CR)-free survival, cancer-specific mortality (CSM)-free survival, and overall survival (OS) were plotted using Kaplan-Meier survival curves. Cox proportional hazards models investigated predictors of CR and CSM. Competing risk regressions were utilized to depict cumulative incidences of death from BCa and death from other causes after RARC at long-term. RESULTS: Pathologic nonorgan-confined BCa was found in 40% of patients, and 7 (7%) patients had positive soft tissue surgical margins. Median (interquartile range [IQR]) number of nodes removed was 11 (6, 14), and 26% of patients had pN+ disease. Median (IQR) follow-up for survivors was 123 (117, 149) months. The 12-year CR-free, CSM-free and overall survival were 55% (95% confidence interval [CI]: 44%, 65%), 62% (95%CI: 50%, 72%), and 34% (95%CI: 24%, 44%) respectively. On multivariable competing risk analysis, nodal involvement at final pathology was associated with higher risk of both CR (hazards ratio [HR]: 1.82; 95%CI: 1.06, 3.13, p=0.030) and CSM (HR: 1.70, 95%CI 1.30, 2.22; p<0.0001). The cumulative incidence of non-cancer death exceeded that of death from BCa after approximately ten years after RARC (Figure 1). CONCLUSIONS: We provided relevant data on the oncologic outcomes of RARC at a high-volume robotic center, with acceptable rates of clinical recurrence and cancer-specific survival at long-term. In patients treated with RARC, the cumulative incidence of death from causes other than BCa is non-negligible, and should be taken into consideration for post-operative follow-up. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e635 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo Mottaran More articles by this author Carlo Bravi More articles by this author Adele Piro More articles by this author Luca Sarchi More articles by this author Marco Paciotti More articles by this author Maria Peraire Lores More articles by this author Eleonora Balestrazzi More articles by this author Luigi Nocera More articles by this author Federico Piramide More articles by this author Ruben De Groote More articles by this author Frederiek D'hondt More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

Survival Benefits of Adjuvant Chemotherapy for Positive Soft Tissue Surgical Margins Following Radical Cystectomy in Bladder Cancer with Extravesical Extension

Muscle invasive bladder cancer with extravesical extension is an aggressive disease entity that requires multimodal therapy. The benefits of adjuvant chemotherapy (AC) in patients with a positive soft-tissue surgical margin (STSM), however, are relatively unknown due to exclusion of this population in randomized controlled trials of AC. We sought to define survival benefits in this patient population through our institutional bladder cancer database. Retrospective review of all patients undergoing radical cystectomy for urothelial carcinoma of the bladder from 2004-2020 with ≥pT3b disease irrespective of neoadjuvant chemotherapy (NAC) use was conducted. Progression-free survival (PFS) and overall survival (OS) estimates were obtained using the Kaplan-Meier method with log-rank test, and the Cox-proportional hazards model was used to identify predictors of improved PFS and OS. AC was defined by any chemotherapy use within 90 days of cystectomy, regardless of STSM status. 476 patients with pT3b disease or worse were identified. Median follow-up was 12.3 months. An amount of 21% of patients were treated with AC. An amount of 24% of patients had positive STSM. Median OS for patients with positive STSM was 8.4 months [95% CI 7-11.5] and 18.3 months [95% CI 15.6-20.8] (p < 0.001) for patients with negative STSM. In the overall cohort, positive STSM (HR 1.93, 95% CI 1.45-2.57, p < 0.001), AC use (HR 0.68, 95% CI 0.51-0.90, p = 0.007), and pN1-3 disease (HR 1.47, 95% CI 1.16-1.87, p = 0.002) were independent predictors of OS when adjusted for performance status, pT-stage, and neoadjuvant chemotherapy use. In patients with positive STSM, median survival was seven months [95% CI 5.2-8.4] without AC, compared to 16.2 months [95% CI 11.5-52.5] with AC (p = 0.0038). For patients with negative STSM, median survival was 17.4 months [95% CI 14-20.1] without AC compared to 22.3 months [95% CI 17.2-36.9] with AC (p = 0.23). In patients with positive STSM, AC use was the only factor associated with an OS benefit with a HR of 0.41 (95% CI 0.21-0.78, p = 0.007). In patients with negative STSM, pT4 and pN1-3 disease were the only factors associated with worse overall survival with a HR of 1.32 (95% CI 1.00-1.74, p = 0.050) and 1.97 (95% CI 1.49-2.60, p < 0.001), respectively. Administration of adjuvant chemotherapy is of particular benefit in patients with positive STSM following radical cystectomy for gross extravesical disease. Positive STSM may be a representative of "early metastatic" or micrometastatic disease.

The Predictive and Prognostic Value of Precystectomy Serum Gamma-Glutamyltransferase Levels in Patients With Invasive Bladder Cancer.

The aim of the study was to elucidate the predictive and prognostic value of serum gamma-glutamyltransferase (GGT) in patients with invasive bladder cancer (BC). Preoperative serum GGT concentrations were assessed in 324 patients treated with RC for cM0 BC between 2002 and 2013. Laboratory values were obtained 1 to 3 days prior to RC. Uni- and multivariable analyses were carried out to evaluate clinicopathologic risk factors for survival. The median follow-up was 36 months (IQR: 10-55). Elevated preoperative GGT levels were diagnosed in 77 patients (23.8%). Elevated GGT was significantly associated with higher ECOG PS and tumor stage (both P= .001), lymph-node tumor involvement (P < .001), positive surgical margins (P= .018), lymphovascular invasion (P= .024), muscle-invasive disease at primary diagnosis (P= .033), increased tumor size (P= .035), hydronephrosis at RC (P= .049) and increased preoperative CRP, GPT and GOT levels (both P < .001). Patients with elevated GGT had decreased 3-year overall (49.2% vs. 69.6%; P= .005) and cancer-specific survival (71.1% vs. 80.9%; P= .042) compared with patients with normal levels. On multivariable analysis, advanced tumor stage (P= .032), lymph node positive disease (P= .030), positive soft tissue surgical margins (P= .014), hydronephrosis at RC (both P= .010), higher ECOG performance status and elevated GGT (P= .043) levels were independent predictors of all-cause mortality. Elevated preoperative serum GGT levels are associated with increased risk of locally advanced BC and mortality after RC. These data suggest that GGT levels may be useful for improved prognostication in invasive BC.

Quality indicators for the management of muscle-invasive bladder cancer in the perioperative setting of radical cystectomy: a narrative review.

Background and ObjectiveIdentifying evidence-based and measurable quality-of-care indicators is crucial for optimal management of patients requiring radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). RC with urinary diversion and lymphadenectomy is the standard treatment for patients with MIBC. Preoperatively, neoadjuvant chemotherapy (NAC) with cisplatin-based combinations improves survival outcomes and is the recommended standard of care for eligible patients. Intraoperatively, lymph node dissection (LND) by, at least, following a standard pelvic lymph node template improves overall- and recurrence-free survival and allows for accurate tumour staging. Avoiding positive soft tissue surgical margins (STSM) should be a main target intraoperatively since they are almost universally associated with mortality. Implementing enhanced recovery after surgery (ERAS) programs can reduce lengths of hospital stay (LOS) and postoperative complication rates without increasing readmission rates after RC. Moreover, several studies have shown that smoking negatively affects local and systemic treatment outcomes in bladder cancer (BC) patients. Therefore, smoking cessation counselling for smokers should be an essential part of bladder cancer management regardless of the disease state.MethodsWe performed a comprehensive, non-systematic review of the latest literature to define indicators representing the best evidence available for optimal care of MIBC patients treated with RC.Key Content and FindingsIn this review, we propose five major quality indicators that are easily implementable for optimized management of MIBC patients treated with RC, including: usage of cisplatin-based NAC in eligible patients, ensurance of negative STSM, performance of (at least) a standard pelvic template LND, implementation of ERAS strategies, and professional smoking cessation counselling.ConclusionsOptimal management of MIBC needs to be framed by evidence-based, reproducible, and measurable quality indicators that will allow for guidance and comparative effectiveness assessment of clinical practices; adherence to them is likely to improve patients’ prognoses by a tensible margin. For the treatment of MIBC patients with RC, we identified five essential quality indicators.KeywordsAssessment; bladder cancer (BC); muscle-invasive bladder cancer (MIBC); cystectomy; radical cystectomy (RC); quality

Oncologic Equipoise Between Robotic and Open Radical Cystectomy.

Purpose: Our objective was to establish the incidence of positive surgical margins, recurrence patterns, and recurrence-free (RFS) and overall survival (OS) in a large cohort of patients undergoing robotic (robot-assisted radical cystectomy [RARC]) and open radical cystectomy (ORC). Materials and Methods: We performed a large retrospective cohort study at a high-volume academic tertiary referral center. Patients were those who underwent RC for bladder cancer from 2005 to 2017. Patients were allocated to ORC or RARC by patient and surgeon choice. Propensity matching and a multivariable analysis were performed to determine factors predictive of RFS and OS after RC. All analyses were done with SAS 9.4. Results: The study included 1885 patients, 13.5% of whom underwent RARC. There was no difference in positive soft tissue surgical margins (2.4% in ORC and 1.2% in RARC). There were no differences in recurrence patterns, nor in the severity of pathology distribution between the two cohorts. Peritoneal carcinomatosis was seen in 1.1% of ORC and 0.8% in RARC. Shorter RFS was associated with younger age (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.03-1.05, p < 0.001), neoadjuvant chemotherapy (HR 1.41, 95% CI 1.14-1.75, p = 0.002), higher pathologic stage (stage ≥T2 HR 2.45, 95% CI 1.91-3.16, p < 0.001), lymph node positivity at cystectomy (HR 1.92, 95% CI 1.50-2.47, p < 0.001), and positive surgical margins (HR 1.49, 95% CI 1.09-2.05, p = 0.01). RFS and OS did not differ by surgical approach (HR 1.04, 95% CI 0.83-1.30), p = 0.75 and (HR 0.89, 95% CI 0.67-1.19), p = 0.43, respectively. Conclusion: The data from this study support continued use of RARC as a safe oncologic procedure, with similar outcomes to ORC.

Rates and Patterns of Recurrences and Survival Outcomes after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium.

There have been concerns about higher incidence of local and retroperitoneal recurrences after robot-assisted radical cystectomy compared to open radical cystectomy. We report and detail relapses following robot-assisted radical cystectomy using a multinational database. A retrospective review of the International Robotic Cystectomy Consortium was performed. Data were reviewed for demographics, and perioperative, pathological and oncologic outcomes. Relapse rates and patterns were analyzed. Kaplan-Meier curves were used to depict relapse-free, local recurrence-free, distant metastasis-free and overall survival. Kaplan-Meier curves were further stratified by disease stage, lymph node status and margins. Multivariate stepwise Cox regression models were used to identify variables associated with relapse-free, local recurrence-free, distant metastasis-free and overall survival. Of 2,107 patients 521 (25%) experienced disease relapse. Mean age (SD) was 68±10 years with a median followup of 26 (IQR 11-55) months for the study cohort. Local recurrences were observed in 11% and distant metastases in 18%. Early oncologic failure (within 3 months) occurred in 4% of patients. The most common sites of local recurrence and distant metastasis were the pelvis (5%) and lungs (6%)/extrapelvic lymph nodes (5%), respectively. Abdominal wall/port site metastasis occurred in 1.2% and peritoneal carcinomatosis in 1.2%. Five-year relapse-free, local recurrence-free, distant metastasis-free and overall survival was 66%, 84%, 74% and 60%, respectively. Patients with higher disease stage, positive lymph nodes and positive soft tissue surgical margins demonstrated worse relapse-free, local recurrence-free, distant metastasis-free and overall survival (log rank p <0.01 for all comparisons). Multivariate regression models identified that node positive status and disease stage (pT3 or greater) were significantly associated with relapse-free, local recurrence-free, distant metastasis-free and overall survival (p <0.01). Disease stage remains the main variable associated with disease relapse and survival following radical cystectomy. Robot-assisted radical cystectomy was not associated with different patterns or higher relapse rates compared to historic open radical cystectomy data.

V12-06 FEMALE ORGAN-SPARING ROBOT-ASSISTED RADICAL CYSTECTOMY: TECHNIQUE AND INITIAL EXPERIENCE

You have accessJournal of UrologyBladder Cancer & Urinary Diversion (V12)1 Apr 2020V12-06 FEMALE ORGAN-SPARING ROBOT-ASSISTED RADICAL CYSTECTOMY: TECHNIQUE AND INITIAL EXPERIENCE Ahmed Elsayed*, Hannah Ely, Naif Aldhaam, Yousuf Ramahi, Julian Joseph, Mohammad Durrani, Ahmed Hussein, and Khurshid Guru Ahmed Elsayed*Ahmed Elsayed* More articles by this author , Hannah ElyHannah Ely More articles by this author , Naif AldhaamNaif Aldhaam More articles by this author , Yousuf RamahiYousuf Ramahi More articles by this author , Julian JosephJulian Joseph More articles by this author , Mohammad DurraniMohammad Durrani More articles by this author , Ahmed HusseinAhmed Hussein More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000957.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anterior pelvic exenteration is the standard of care for female patients with muscle invasive, as well as refractory non-muscle invasive bladder cancer. Female organ-sparing robot-assisted radical cystectomy (FsRARC) is a feasible option for selected patients. We hereby report the technique and initial perioperative outcomes of a FsRARC. METHODS: We identified 5 patients who underwent FsRARC for bladder cancer at Roswell Park Comprehensive Cancer Center. Demographics, perioperative and pathological outcomes were collated and reported. RESULTS: Mean age was 53 ± SD 19 years and mean body mass index was 26 ± SD 5. Median overall operative time was 391 minutes (IQR 361-429). Median estimated blood loss was 150 ml (IQR 120-250). All patients underwent intracorporeal urinary diversion and only one patient received a neobladder. Median hospital stay was 4 days (IQR 3-8). Median number of lymph nodes resected was 22 (IQR 18-35). One patient had ≥pT3, two had positive lymph nodes, and one patient had positive soft tissue surgical margin. One patient exhibited high grade complications and readmission. There were no perioperative reoperations, or mortality. At a median follow up of 7 months, only one patient had local pelvic recurrence. CONCLUSIONS: Female organ-sparing RARC seems feasible in select patients. Larger cohorts with longer follow up are required to ensure feasibility and oncologic safety. Source of Funding: Roswell Park Alliance Foundation © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1111-e1112 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Elsayed* More articles by this author Hannah Ely More articles by this author Naif Aldhaam More articles by this author Yousuf Ramahi More articles by this author Julian Joseph More articles by this author Mohammad Durrani More articles by this author Ahmed Hussein More articles by this author Khurshid Guru More articles by this author Expand All Advertisement PDF downloadLoading ...

Unexpected Early Oncologic Mortality after Open Radical Cystectomy for Bladder Cancer: Who Is to Be Blamed?

Purpose: To investigate prevalence and variables associated with early oncologic mortality (EOM; within ≥30 to ≤90 days) of open radical cystectomy (RC) for bladder cancer. The unexpected rapidity of tumour recurrence and the huge metastatic burden of these patients drew us to analyse this cohort. Methods: We reviewed our RC database. All 1,487 patients were treated with curative intent between January 1986 and December 2008. Imaging for staging was done by CT (chest) and CT or MRI (abdomen). Clinical and histopathological variables were recorded until death to determine whether disease- or treatment-related factors were associated with mortality. Results: There were 93 deaths within 90 days of surgery. Twenty-four patients died from early progression to high volume disseminated metastatic disease. Group 1: unresectable tumours, which were never free of disease. Group 2: resectable tumours, considered tumour-free after RC. Group 1 is characterized by local tumour spread and a low distant failure rate. Group 2 has a low local and a high distant failure rate. Conclusions: Disease related (advanced tumour stage, positive soft tissue surgical margins (+STSM), non urothelial histology, unresectable tumours, atypical occult metastasis), rather than technical factors, had the leading role in EOM. Understaging was universal.

Prognostic impact of tumor-associated immune cell infiltrates at radical cystectomy for bladder cancer

ObjectivesTo assess whether the presence and location of tumor-associated immune cell infiltrates (TAIC) on histological slides obtained from cystectomy specimens impacts on oncological outcomes of patients with bladder cancer (BC). Material and methodsA total of 320 consecutive patients staged with cM0 bladder cancer underwent radical cystectomy (RC) between 2004 and 2013. The presence of TAIC (either located peritumorally [PIC] and/or intratumorally [IIC]) on histological slides was retrospectively assessed and correlated with outcomes. Kaplan–Meier analyses were used to estimate the impact of TAIC on recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS). Multivariable Cox-regression analysis was carried out to evaluate risk factors of recurrence. The median follow-up was 37 months (IQR: 10–55). ResultsOf the 320 patients, 42 (13.1%) exhibited IIC, 141 (44.1%) PIC and 137 (42.8%) no TAIC in the cystectomy specimens. Absence of TAIC was associated with higher ECOG performance status (P = 0.042), histologically advanced tumor stage (≥pT3a; P < 0.001), lymph node tumor involvement (pN+; P = 0.022), positive soft tissue surgical margins (P = 0.006), lymphovascular invasion (P < 0.001), and elevated serum C-reactive protein levels (P < 0.001). The rate of never smokers was significantly higher in the IIC-group (64.3%) compared to the PIC-group (39.7%, P = 0.007) and those without TAIC (35.8%, P = 0.001). The 3-year RFS/CSS/OS was 73.9%/88.5%/76.7% for patients with IIC, 69.4%/85.2%/70.1% for PIC and 47.6%/68.5%/56.1% for patients without TAIC (P < 0.001/<0.001/0.001 for TAIC vs. no TAIC). In multivariable analysis, adjusted for all significant parameters of univariable analysis, histologically advanced tumor stage (P = 0.003), node-positive disease (P = 0.002), and the absence of TAIC (P = 0.035) were independent prognosticators for recurrence. ConclusionsIn this analysis, the presence and location of TAIC in cystectomy specimens was a strong prognosticator for RFS after RC. This finding suggests that the capability of immune cells to migrate into the tumor at the time of RC is prognostically important in invasive bladder cancer.

Ten-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium.

Radical cystectomy is the gold standard for nonmetastatic muscle invasive bladder cancer and for refractory nonmuscle invasive disease. Compared to open radical cystectomy, robot-assisted radical cystectomy has been shown to provide comparable early oncologic outcomes and improved perioperative outcomes. However, there is a paucity of data on long-term oncologic outcomes and concerns about a higher incidence of local recurrence after robot-assisted radical cystectomy. We report 10-year oncologic outcomes following robot-assisted radical cystectomy using a multinational database. We retrospectively reviewed the prospective International Robotic Cystectomy Consortium database. Consecutive patients who underwent robot-assisted radical cystectomy 10 years ago or earlier were included in analysis. Data were reviewed for demographics, and perioperative, pathological and oncologic outcomes. Kaplan-Meier curves were used to depict recurrence-free, disease specific and overall survival. Multivariate stepwise Cox regression models were applied to identify variables associated with recurrence-free, disease specific and overall survival. We identified 446 patients with a median age of 67 years (IQR 59-76). Of the patients 10% received neoadjuvant chemotherapy, 51% experienced any complication, 23% had high grade complications and 4% died within 3 months of robot-assisted radical cystectomy. Disease was pT3 or greater in 43% of patients and pN+ in 24% while a positive soft tissue surgical margin was observed in 7%. At a median followup of 5 years (IQR 2-10, maximum 14) local and distant recurrence had developed in 15% and 29% of patients, respectively. Ten-year recurrence-free, disease specific and overall survival rates were 59%, 65% and 35%, respectively. Patients with pT3 or greater and pN+ disease showed worse recurrence-free, disease specific and overall survival. Long-term oncologic outcomes, and recurrence rates and patterns after robot-assisted radical cystectomy seem comparable to those in open series. Advanced disease stage and positive surgical margins remain the main determinants of survival after radical cystectomy.

The impact of completeness of last transurethral resection of bladder tumors on the outcomes of radical cystectomy.

To evaluate the role of a complete transurethral resection of bladder tumors (c-TURBT) on oncological outcomes after radical cystectomy (RC) and its relationship with adverse pathological features. We retrospectively analyzed data of 727 patients treated with RC and bilateral pelvic lymph node dissection at three tertiary referral centers. Possible c-TURBT was reported by the treating surgeon. Multivariable Cox regression analyses were used to assess the relationship of c-TURBT and survival outcomes after surgery in 1:1 propensity score-matched cohort adjusted for age and gender. Moreover, multivariable logistic regression (MVA) was built to predict the relationship between c-TURBT and pT3-T4 stages at RC, lymph node invasion (LNI) and positive soft tissue surgical margin (STSM). A total of 433 (60%) patients received a c-TURBT. 3.0% of patients with a c-TURBT achieved a pT0-pTa-pTis status vs. 2.0% of patients with incomplete TURBT. At multivariable Cox regression analyses, c-TURBT was not associated with survival outcomes. At MVA, incompleteness of TURBT was significantly associated with a pT3-T4 stage [odds ratio (OR) 8.04, 95% confidence interval (CI) 2.33-27.67, p = 0.001]. No significant association was found between c-TURBT, LNI and STSM. We found a low rate of achievement of pT0 stage at RC. An incomplete TURBT before RC represented a predictor of pT3-T4 stages, but no effect of a c-TURBT was shown on survival outcomes. Given the current inadequacy of clinical staging strategies with more than 50% of extravesical disease being under-staged, our results could improve patients selection for NAC, driving the decision-making in doubtful cases.

Histologic variants associated with biological aggressiveness and poor prognosis in patients treated with radical cystectomy.

The prognostic value of histologic variants (HV) after radical cystectomy (RC) remains controversial. We evaluated the clinicopathological features and prognosis in patients with pure urothelial carcinoma (UC) and HV following RC. From 1990 to 2015, 286 patients with bladder cancer were treated with RC at six Kitasato University-affiliated hospitals. All patients were divided into two groups: pure UC and HV, which contained pure variants and mixed-type UC with variant pattern. A comparison of patient characteristics between the two groups was made to assess the clinicopathological features, and statistical analyses were performed to investigate prognosis in the two groups. Of the 286 patients, 226 (79%) had pure UC, while 60 (21%) had HV. Of all HV, pure variants accounted for 45% (n = 27). The prevalence of lymph node involvement, locally advanced stage (≥ pT3), positive soft tissue surgical margin and lymphovascular invasion were significantly higher in patients with HV than in those with pure UC. Patients with HV showed worse disease-free survival and cancer-specific survival than those with pure UC (P = 0.009 and 0.003, respectively). In multivariate analysis, HV and lymph node involvement were independent predictors of worse disease-free survival (P = 0.017 and 0.001, respectively). HV, locally advanced stage, lymph node involvement, and positive soft tissue surgical margin were also confirmed as independent predictors of worse cancer-specific survival (P = 0.011, 0.012, 0.003 and 0.010, respectively.). HV was associated with greater biological aggressiveness and worse prognosis than pure UC.

Propensity-score-matched comparison of soft tissue surgical margins status between open and robotic-assisted radical cystectomy

IntroductionThe use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safety is accepted, its oncological efficacy as compared to the current standard, open radical cystectomy (ORC), remains debatable. Materials and methodsThe aim of this study is to compare the rates of positive soft tissue surgical margins (STSM), between patients treated with RARC or ORC, using a large contemporaneous collaborative database. We included 2,536 patients with urothelial carcinoma of the bladder treated at 26 institutions. A propensity-score matching 1:1 was performed with 3 ORC patients matched to 1 RARC patient. The final cohort included 1,614 patients. Uni- and multivariable logistic regression analyses tested the impact of surgical technique on STSM status, before and after propensity-score matching. ResultsOverall, 870 (34%) patients underwent RARC and 1,666 (66%) ORC. The overall STSM rate was 11%; 10% in the ORC group and 13% in the RARC group. Within the propensity-score-matched cohort, the positive STSM rate were 14% and 13% in the ORC and RARC group, respectively (P = 0.1). In multivariable analysis, after propensity match RARC approach was not associated with the risk of a positive STSM (P = 0.1). These results were confirmed in the subgroup of patients with pathologic non–organ-confined or organ-confined diseases. ConclusionsWhile treatment with RARC is associated with a higher absolute rate of STSM, the difference did not remain after adjustment for the effects of other established prognostic factors. Results from ongoing trials are awaited to assess the validity of these findings.

The Impact of Plasmacytoid Variant Histology on the Survival of Patients with Urothelial Carcinoma of Bladder after Radical Cystectomy

BackgroundThe clinical significance of the plasmacytoid variant (PCV) in urothelial carcinoma (UC) is currently lacking. ObjectiveTo compare clinical outcomes of patients with any PCV with that of patients with pure UC treated with radical cystectomy (RC). Design, setting, and participantsWe identified 98 patients who had pathologically confirmed PCV UC and 1312 patients with pure UC and no variant history who underwent RC at our institution between 1995 and 2014. Outcome measurements and statistical analysisUnivariable and multivariable Cox regression and Cox proportional hazards regression to determine if PCV was associated with overall survival (OS). Results and limitationsPatients with PCV UC were more likely to have advanced tumor stage (p=0.001), positive lymph nodes (p=0.038), and receive neoadjuvant chemotherapy than those with pure UC (46% vs 22%, p<0.0001). The rate of positive soft tissue surgical margins was over five times greater in the PCV UC group compared with the pure UC group (21% vs 4.1%, respectively, p<0.0001). Median OS for the pure UC versus the PCV patients were 8 yr and 3.8 yr, respectively. On univariable analysis, PCV was associated with an increased risk of overall mortality (hazard ratio=1.34, 95% confidence interval: 1.02–1.78, p=0.039). However, on multivariable analysis adjusted for age, sex, neoadjuvant chemotherapy received, lymph node status, pathologic stage, and soft margin status, the association between PCV and OS was no longer significant (hazard ratio=1.06, 95% confidence interval: 0.78, 1.43, p=0.7). This retrospective study is limited by the lack of pathological reanalysis, and the impact of other concurrent mixed histology cannot be determined in this study. ConclusionsPatients with PCV features have a higher disease burden at RC compared with those with pure UC. However, PCV was not an independent predictor of survival after RC on multivariable analysis, suggesting that PCV histology should not be used as an independent prognostic factor. Patient summaryPlasmacytoid urothelial carcinoma is a rare and aggressive form of bladder cancer. Patients with plasmacytoid urothelial carcinoma had worse adverse pathologic features, but this was not associated with worse overall mortality when compared with patients with pure urothelial carcinoma.

Is transurethral resection alone enough for the diagnosis of histological variants? A single-center study

IntroductionTo evaluate incidence of histological variants and grade agreement between transurethral resection (TUR) and radical cystectomy (RC) in patients with bladder cancer. MethodsA total of 779 patients treated with TUR and subsequently with RC between 1990 and 2013 at a single center were analyzed retrospectively. Variant histology classifications used in our analyses were sarcomatoid, small cell, squamous, or micropapillary. Grade agreement was calculated using the Cohen kappa coefficient. Logistic regression analyses were built to predict adverse pathologic features from histological variants at TUR. ResultsConsidering TUR, 213 (27.3%) patients were diagnosed with histological variants. Of these, 2.1% (n = 16) were found with sarcomatoid variant, 1.7% (n = 13) with small cell, 7.1% (n = 55) with squamous, 12.5% (n = 97) with micropapillary. Considering RC, 212 (27.2%) patients were diagnosed with histological variants. Poor agreement was found considering micropapillary variant and the presence of a histological variant in general (0.11 and 0.27, respectively). Intermediate agreement was found analyzing the presence of sarcomatoid, small cell, and squamous variants (0.43, 0.61, and 0.61, respectively). Small cell carcinoma at TUR was found associated with an increased risk of harboring positive soft tissue surgical margin (odds ratio = 2.08; CI: 1.27–3.41; P = 0.03). ConclusionsOne out of our patients with bladder cancer was diagnosed with a histological variant either at TUR and RC. We found poor agreement between TUR and RC. Our findings highlight that TUR alone is not sufficient to accurately evaluate the presence of histological variants that may have an effect on treatment and survival outcomes.

MP58-01 INCOMPLETENESS OF THE TRANSURETHRAL RESECTION AS A PREDICTOR OF ADVERSE PATHOLOGICAL FEATURES AT THE TIME OF RADICAL CYSTECTOMY: IMPLICATIONS FOR NEOADJUVANT CHEMOTHERAPY SELECTION

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2017MP58-01 INCOMPLETENESS OF THE TRANSURETHRAL RESECTION AS A PREDICTOR OF ADVERSE PATHOLOGICAL FEATURES AT THE TIME OF RADICAL CYSTECTOMY: IMPLICATIONS FOR NEOADJUVANT CHEMOTHERAPY SELECTION Marco Moschini, Marco Bandini, Giusy Burgio, Giovanni La Croce, Emanuele Zaffuto, Andrea Gallina, Agostino Mattei, Rocco Damiano, Vincenzo Mirone, Shahrokh Shariat, Alberto Briganti, Francesco Montorsi, and Renzo Colombo Marco MoschiniMarco Moschini More articles by this author , Marco BandiniMarco Bandini More articles by this author , Giusy BurgioGiusy Burgio More articles by this author , Giovanni La CroceGiovanni La Croce More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Rocco DamianoRocco Damiano More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Renzo ColomboRenzo Colombo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1796AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neoadjuvant chemotherapy (NAC) before radical cystectomy improves survival expectations in cT2-T4a bladder cancer (BCa) patients. However, this effect is more evident in patients with cT3 or higher disease. Several studies evaluated factors associated with might help in selecting patients who might benefit more from NAC before RC. However, none of them investigated the role of the completeness of transurethral resection (TUR) before RC which may represents a useful proxy of tumor extension in RC candidates. We therefore evaluated a cohort of patients treated with RC due to BCa stratifying according the completeness of TUR before RC. METHODS We retrospectively analyzed data of 481 patients treated with RC and bilateral PLND without NAC due to nonmetastatic BCa between 1990 and 2013 and complete data regarding the completeness of pre-cystectomy TUR. TUR were completed when possible, when not feasible physicians reported this aspect in a prospective maintained database. Demographics and preoperative RC data were available for all patients. Univariable and multivariable logistic regression were built predicting the impact of completeness of TUR and adverse pathologic T stage (defined as T3-T4), lymph node invasion (LNI) and positive soft tissue surgical margin (STSM) status. Multivariable models were adjusted for clinical T stage, presence of CIS or lymphovascular invasion at TUR, histology at TUR, age and preoperative idronephrosis. Area under curve (AUC) was calculated predicting adverse pathologic features with and without the completeness of TUR. RESULTS Overall, TUR has been completed in 326 (67.8%) patients submitted to RC. Patients where the TUR was not completed had higher cT3-4 disease, higher LVI, higher CIS and higher cN+ diseases. At univariable analyses, incompleteness of TUR was a predictor of LNI (odds ratio [OR]: 1.66, confidence interval [CI]: 1.08-2.55, p=0.02), adverse pathologic stage (OR: 1.78, CI: 1.21-2.62, p=0.003), positive STSM (OR: 2.15, CI: 1.13-4.10, p=0.02). At multivariable analyses, completeness of TUR was a predictor of positive STSM (OR: 2.18, CI: 1.12-4.25, p=0.02) and adverse pathologic T stage (OR: 1.57, CI: 1.03-2.40, p=0.03) but not in the prediction of LNI (p=0.06). The inclusion of completeness of TUR in our preoperative model increases of 3.5% its accuracy (AUC: 76.2 vs. 72.7 with or without completeness of TUR, respectively). CONCLUSIONS Incompleteness of the TUR before RC represents a predictor of adverse pathologic features at RC. Physicians should consider this aspect in predicting RC patients' survival and eventually the necessity of neoadjuvant chemotherapy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e772 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marco Moschini More articles by this author Marco Bandini More articles by this author Giusy Burgio More articles by this author Giovanni La Croce More articles by this author Emanuele Zaffuto More articles by this author Andrea Gallina More articles by this author Agostino Mattei More articles by this author Rocco Damiano More articles by this author Vincenzo Mirone More articles by this author Shahrokh Shariat More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Renzo Colombo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP58-09 PREDICTING LOCAL FAILURE AFTER RADICAL CYSTECTOMY IN BLADDER CANCER PATIENTS: IMPLICATIONS FOR THE SELECTION OF CANDIDATES AT ADJUVANT RADIATION THERAPY

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2017MP58-09 PREDICTING LOCAL FAILURE AFTER RADICAL CYSTECTOMY IN BLADDER CANCER PATIENTS: IMPLICATIONS FOR THE SELECTION OF CANDIDATES AT ADJUVANT RADIATION THERAPY Marco Moschini, Andrea Gallina, Nicola Fossati, Stefano Luzzago, Rocco Damiano, Agostino Mattei, Shahrokh Shariat, Vincenzo Mirone, Giusy Burgio, Andrea Salonia, Alberto Briganti, Francesco Montorsi, and Renzo Colombo Marco MoschiniMarco Moschini More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Stefano LuzzagoStefano Luzzago More articles by this author , Rocco DamianoRocco Damiano More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Giusy BurgioGiusy Burgio More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Renzo ColomboRenzo Colombo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1804AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Local failure (LF) after radical cystectomy (RC) due to bladder cancer (BCa) is a common and deadly event. Clinical trials are currently evaluating the impact of adjuvant radiotherapy on the reduction of LF, however scarce data exists about selection of candidates who might benefit from multimodal approach. METHODS We focused on 1112 patients treated with RC and pelvic lymph node dissection, between 1990 and 2012, at a single tertiary referral center. LF was defined as imaging evidence of recurrence in the pelvic soft tissues or nodes below the aortic bifurcation before or within 3 months of detection of distant metastases. Kaplan-Meier log-rank, univariable and multivariable competing risk analyses tested the relationship between clinical and pathological factors and the risk to develop LF during follow up period. Regression tree analysis stratified patients into risk-groups based on their tumor characteristics and the corresponding LF rate. RESULTS Of the 1,122 individuals included in the study, 50 (4.5%) developed LF during follow up period. Median (IQR) follow-up was 62 (35-92) months. At univariable competing risk regression, pathological T stage pT4 vs. pT3 (Hazard Ratio [HR]: 2.55, p=0.003), positive soft tissue surgical margin (STSM) vs. negative (HR: 2.95, p=0.005) and non-pure transitional vs. pure transitional histology (HR: 1.79, p=0.03) were associated with an increased risk of developing LF. On the basis of these variables, the cohort was stratified into four risk groups: very low risk (=pT3a disease, pure transitional histology and negative STSM), low risk (=pT3a disease, non-pure transitional histology and negative STSM), intermediate risk (pT4 disease, negative STSM and any histology), and high risk (all patients with positive STSM). CONCLUSIONS LF is a common event in RC patients. We developed a new risk model based on BCa characteristics. Our findings should be considered by threating physicians when deciding the necessity of adjuvant radiotherapy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e775-e776 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marco Moschini More articles by this author Andrea Gallina More articles by this author Nicola Fossati More articles by this author Stefano Luzzago More articles by this author Rocco Damiano More articles by this author Agostino Mattei More articles by this author Shahrokh Shariat More articles by this author Vincenzo Mirone More articles by this author Giusy Burgio More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Renzo Colombo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...