Risk factors associated with positive surgical margins' location at radical cystectomy and their impact on bladder cancer survival

Francesco Claps^#^{1

2}, Maaike W van de Kamp^#¹, Roman Mayr^#³, Peter J Bostrom^{4

5}, Joost L Boormans⁶, Markus Eckstein⁷, Laura S Mertens¹, Egbert R Boevé⁸, Yann Neuzillet^{1

9}, Maximilian Burger³, Damien Pouessel^{9

10}, Carlo Trombetta², Bernd Wullich¹¹, Theo H van der Kwast¹², Arndt Hartmann⁷, Yves Allory^{9

13}, Yair Lotan¹⁴, Shahrokh F Shariat^{14

15

16

17

18}, Tahlita C M Zuiverloon⁶, M Carmen Mir¹⁹, Bas W G van Rhijn^{20

21

22}

Affiliations

¹ Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
² Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy.
³ Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany.
⁴ Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
⁵ Department of Urology, Turku University Hospital and University of Turku, Turku, Finland.
⁶ Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
⁷ Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany.
⁸ Department of Urology, St Franciscus Hospital, Rotterdam, The Netherlands.
⁹ Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, 75005, Paris, France.
¹⁰ Department of Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, 31000, Toulouse, France.
¹¹ Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany.
¹² Department of Pathology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
¹³ Department of Pathology, Institut Curie, 75005, Paris, France.
¹⁴ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁵ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁶ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹⁷ Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
¹⁸ Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁹ Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain.
²⁰ Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. b.v.rhijn@nki.nl.
²¹ Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany. b.v.rhijn@nki.nl.
²² Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada. b.v.rhijn@nki.nl.

^# Contributed equally.

PMID: 34196758
DOI: 10.1007/s00345-021-03776-5

Free article

Multicenter Study

Risk factors associated with positive surgical margins' location at radical cystectomy and their impact on bladder cancer survival

Francesco Claps et al. World J Urol. 2021 Dec.

Free article

. 2021 Dec;39(12):4363-4371.

doi: 10.1007/s00345-021-03776-5. Epub 2021 Jul 1.

Authors

Affiliations

¹ Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
² Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy.
³ Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany.
⁴ Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
⁵ Department of Urology, Turku University Hospital and University of Turku, Turku, Finland.
⁶ Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
⁷ Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany.
⁸ Department of Urology, St Franciscus Hospital, Rotterdam, The Netherlands.
⁹ Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, 75005, Paris, France.
¹⁰ Department of Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, 31000, Toulouse, France.
¹¹ Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany.
¹² Department of Pathology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
¹³ Department of Pathology, Institut Curie, 75005, Paris, France.
¹⁴ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁵ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁶ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹⁷ Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
¹⁸ Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁹ Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain.
²⁰ Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. b.v.rhijn@nki.nl.
²¹ Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany. b.v.rhijn@nki.nl.
²² Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada. b.v.rhijn@nki.nl.

^# Contributed equally.

PMID: 34196758
DOI: 10.1007/s00345-021-03776-5

Abstract

Purpose: To evaluate the risk factors associated with positive surgical margins' (PSMs) location and their impact on disease-specific survival (DSS) in patients with bladder cancer (BCa) undergoing radical cystectomy (RC).

Methods: We analyzed a large multi-institutional cohort of patients treated with upfront RC for non-metastatic (cT1-4aN0M0) BCa. Multivariable binomial logistic regression analyses were used to assess the risk of PSMs at RC for each location after adjusting for clinicopathological covariates. The Kaplan-Meier method was used to estimate DSS stratified by margins' status and location. Log-rank statistics and Cox' regression models were used to determine significance.

Results: A total of 1058 patients were included and 108 (10.2%) patients had PSMs. PSMs were located at soft-tissue, ureter(s), and urethra in 57 (5.4%), 30 (2.8%) and 21 (2.0%) patients, respectively. At multivariable analysis, soft-tissue PSMs were independently associated with pathological stage T4 (pT4) (Odds ratio (OR) 6.20, p < 0.001) and lymph-node metastases (OR 1.86, p = 0.04). Concomitant carcinoma-in-situ (CIS) was an independent risk factor for ureteric PSMs (OR 6.31, p = 0.003). Finally, urethral PSMs were independently correlated with pT4-stage (OR 5.10, p = 0.01). The estimated 3-years DSS rates were 58.2%, 32.4%, 50.1%, and 40.3% for negative SMs, soft-tissue-, ureteric- and urethral PSMs, respectively (log-rank; p < 0.001).

Conclusions: PSMs' location represents distinct risk factors' patterns. Concomitant CIS was associated with ureteric PSMs. Urethral and soft-tissue PSM showed worse DSS rates. Our results suggest that clinical decision-making paradigms on adjuvant treatment and surveillance might be adapted based on PSM and their location.

Keywords: Bladder; Cancer; Cystectomy; Margin; Soft tissue; Ureter; Urethra; Urothelial carcinoma.

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References

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Risk factors associated with positive surgical margins' location at radical cystectomy and their impact on bladder cancer survival

Affiliations

Risk factors associated with positive surgical margins' location at radical cystectomy and their impact on bladder cancer survival

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous