Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival Journal Article

  

Authors:	Dotan, Z. A.; Kavanagh, K.; Yossepowitch, O.; Kaag, M.; Olgac, S.; Donat, M.; Herr, H. W.
Article Title:	Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival
Abstract:	Purpose: We evaluated risk factors for positive soft tissue surgical margins and the impact of soft tissue surgical margins on metastatic progression and disease specific survival in patients treated with radical cystectomy for bladder cancer. Materials and Methods: A total of 1,589 patients who underwent radical cystectomy for primary urothelial cancer at our institution were included in the study. Several variables were analyzed including gender, age, use of perioperative chemotherapy, tumor stage, tumor grade, presence of carcinoma in situ, pathological vascular invasion, bladder pathology, status of soft tissue surgical margins, lymph node status, number of lymph nodes removed and number of positive lymph nodes. End points were freedom from progression to metastases and disease specific survival. Results: Positive soft tissue surgical margins were detected in 67 patients (4.2%). Risk factors for positive soft tissue surgical margins were female gender (p = 0.04), pathological stage, vascular invasion in the radical cystectomy specimen, lymph node metastases (all p ≤0.001) and median number of positive lymph nodes (p = 0.002). In addition, nonpure transitional cell carcinoma histology (p = 0.001) was associated with positive soft tissue surgical margins. In the 5 years after cystectomy, rates of disease specific survival for the negative and positive soft tissue surgical margin groups were 72% (95% CI 69-75) and 32% (95% CI 19-54), respectively. On multivariate analysis disease specific death was associated with tumor stage, positive soft tissue surgical margins, vascular invasion, presence of positive lymph nodes, number of nodes removed and number of positive nodes. Conclusions: Risk factors for positive soft tissue surgical margins are female gender, locally advanced cancer, presence of vascular invasion and mixed histology. Patients with positive soft tissue surgical margins have poor prognosis, and positive soft tissue surgical margins were found to be independently associated with disease specific death. © 2007 American Urological Association.
Keywords:	immunohistochemistry; adult; cancer survival; aged; aged, 80 and over; middle aged; survival analysis; cancer surgery; survival rate; major clinical study; histopathology; cancer staging; lymph node metastasis; neoplasm staging; cancer grading; prospective studies; neoplasm recurrence, local; proportional hazards models; bladder cancer; risk factor; urinary bladder neoplasms; age; risk assessment; postoperative complication; cancer invasion; registries; probability; carcinoma in situ; cystectomy; urinary bladder; neoplasm metastasis; chi-square distribution; neoplasm invasiveness; age distribution; carcinoma, transitional cell; gender; sex distribution; soft tissue cancer
Journal Title:	Journal of Urology
Volume:	178
Issue:	6
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2007-12-01
Start Page:	2308
End Page:	2313
Language:	English
DOI:	10.1016/j.juro.2007.08.023
PUBMED:	17936804
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-35748944105&partnerID=40&md5=7ef31117d749ea3f0b25a37c9d7bc5b9
Notes:	--- - "Cited By (since 1996): 35" - "Export Date: 17 November 2011" - "CODEN: JOURA" - "Source: Scopus"