Annals of Surgical Oncology, 2014, Vol.21(12), pp.4034-4040
Byline: Matthias May (1), Sabine Brookman-May (2), Maximilian Burger (3), Christian Gilfrich (1), Hans-Martin Fritsche (3), Michael Rink (4), Felix Chun (4), Margit Fisch (4), Florian Roghmann (5), Joachim Noldus (5), Roman Mayr (6), Armin Pycha (6), Vladimir Novotny (7), Manfred Wirth (7), Stefan Vallo (8), Axel Haferkamp (8), Jan Roigas (9), Antonin Brisuda (10), Regina Stredele (11), Bjorn Volkmer (11), Christopher Dechet (12), Marco Schnabel (3), Stefan Denzinger (3), Christian G. Stief (2), Patrick J. Bastian (13), Atiqullah Aziz (4) Abstract: Purpose To evaluate the prognostic value of concomitant seminal vesicle invasion (cSVI) in patients with urothelial carcinoma of the bladder (UCB) and contiguous prostatic stromal infiltration in a large cystectomy series. Methods A total of 385 patients with UCB and contiguous prostatic infiltration comprised our study. Patients were divided in two groups according to cSVI. Median follow-up was 36 months (interquartile range 11--74) the primary end point was cancer-specific mortality. The prognostic impact of cSVI was evaluated using multivariable Cox regression analysis. The predictive accuracy was assessed by a receiver operating characteristic analysis. Results A total of 229 patients (59.5 %) without cSVI comprised group A, and 156 patients (40.5 %) with cSVI comprised group B. Positive lymph nodes (63 vs. 44 %, p 〈 0.001) and positive surgical margins (34 % vs. 14 %, p 〈 0.001) were more common in patients with cSVI. The 5- and 10-year cancer-specific survival rates were 41 % and 32 % (group A) and 21 and 17 % (group B) (p 〈 0.001). In multivariable analysis, pathological nodal stage (hazard ratio [HR] 2.19, p 〈 0.001), soft tissue surgical margin (HR 1.57, p = 0.010), clinical tumor stage (HR 1.46, p = 0.010), adjuvant chemotherapy (HR 0.40, p 〈 0.001), and cSVI (HR 1.69, p 〈 0.001) independently impacted cancer-specific mortality. The c-indices of the multivariable models with and without inclusion of cSVI were 0.658 (95 % confidence interval 0.60--0.71) and 0.635 (95 % confidence interval 0.58--0.69), respectively, resulting in a predictive accuracy gain of 2.3 % (p = 0.002). Conclusions In patients with UCB and prostatic stromal invasion, cSVI adversely affected cancer-specific survival compared to patients without cSVI. The inclusion of cSVI significantly improved the predictive accuracy of our multivariable model regarding survival. Author Affiliation: (1) Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany (2) Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany (3) Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany (4) Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (5) Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany (6) Department of Urology, General Hospital of Bolzano, Bolzano, Italy (7) Department of Urology, University Hospital "Carl Gustav Carus", Dresden Technical University, Dresden, Germany (8) Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany (9) Department of Urology, Vivantes Medical Center Im Friedrichshain and Am Urban, Berlin, Germany (10) Department of Urology, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic (11) Department of Urology, Kassel Medical Center, Kassel, Germany (12) Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA (13) Department of Urology, Paracelsus Medical Center Golzheim, Dusseldorf, Germany Article History: Registration Date: 17/05/2014 Received Date: 17/03/2014 Online Date: 04/06/2014 Article note: Matthias May and Sabine Brookman-May contributed equally to this article, and both should be considered first author.
Adjuvant Chemotherapy – Analysis ; Mortality – Analysis ; Carcinoma – Analysis;
View full text in Springer (Subscribers only)