World Journal of Urology, 2015, Vol.33(3), pp.343-350
Byline: Matthias May (1), Atiqullah Aziz (2,5), Sabine Brookman-May (3), Florian Roghmann (4), Joachim Noldus (4), Michael Rink (5), Felix Chun (5), Margit Fisch (5), Vladimir Novotny (6), Manfred Wirth (6), Roman Mayr (2,7), Armin Pycha (7), Antonin Brisuda (8), Bjorn Volkmer (9), Regina Stredele (9), Christopher Dechet (10), Stefan Vallo (11), Axel Haferkamp (11), Marco Schnabel (2), Stefan Denzinger (2), Jan Roigas (12), Christian G. Stief (3), Christian Gilfrich (1), Patrick J. Bastian (13), Jorg B. Engel (14), Maximilian Burger (2), Hans-Martin Fritsche (2) Keywords: Urothelial carcinoma; Bladder cancer; Radical cystectomy; Vaginal invasion; Uterine invasion; Prognosis Abstract: Purpose To evaluate for the first time the prognostic significance of female invasive patterns in stage pT4a urothelial carcinoma of the bladder in a large series of women undergoing anterior pelvic exenteration. Patients and methods Our series comprised of 92 female patients in total of whom 87 with known invasion patterns were eligible for final analysis. Median follow-up for evaluation of cancer-specific mortality (CSM) was 38 months (interquartile ranges, 21--82 months). The impact on CSM was evaluated using multivariable Cox proportional-hazards regression analysis predictive accuracy (PA) was assessed by receiver operating characteristic analysis. Results Vaginal invasion was noted in 33 patients (37.9 % group VAG), uterine invasion in 20 patients (23 % group UT), and infiltration of both vagina and uterus in 34 patients (39.1 % group VAG + UT). Groups VAG and UT significantly differed from group VAG + UT with regard to the presence of positive soft tissue margins (STM) only. Five-year-cancer-specific survival probabilities in the groups VAG, UT, and VAG + UT were 21, 20, and 21 %, respectively (p = 0.955). On multivariable analysis, only STM status (HR = 2.02, p = 0.023) independently influenced CSM. C-indices of multivariable models for CSM with and without integration of invasive patterns were 0.570 and 0.567, respectively (PA gain 0.3 %, p = 0.526). Conclusions Infiltration of the vagina, the uterus or both is associated with poor 5-year survival rates. With regard to CSM, no difference was detectable between patients with different invasion patterns, thus justifying further collectively including these invasive patterns as stage pT4a. Author Affiliation: (1) Department of Urology, St. Elisabeth Medical Centre Straubing, Straubing, Germany (2) Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany (3) Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany (4) Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany (5) Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (6) Department of Urology, University Hospital "Carl Gustav Carus", Dresden Technical University, Dresden, Germany (7) Department of Urology, General Hospital of Bolzano, Bolzano, Italy (8) Department of Urology, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic (9) Department of Urology, Kassel Medical Centre, Kassel, Germany (10) Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA (11) Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany (12) Department of Urology, Vivantes Medical Centre Im Friedrichshain and Am Urban, Berlin, Germany (13) Department of Urology, Paracelsus Medical Centre Golzheim, Dusseldorf, Germany (14) Department of Gynecology and Obstetrics, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany Article History: Registration Date: 22/04/2014 Received Date: 18/03/2014 Accepted Date: 22/04/2014 Online Date: 10/05/2014 Article note: Matthias May and Atiqullah Aziz have contributed equally to this work.
Urothelial carcinoma ; Bladder cancer ; Radical cystectomy ; Vaginal invasion ; Uterine invasion ; Prognosis
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