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

Abstract

Purpose To evaluate the risk factors associated with positive surgical margins' (PSMs) location and their impact on diseasespecific 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.

Extraperitoneal laparoscopic radical cystectomy with intracorporeal neobladder: a comparison with transperitoneal approach

“…In a USA cohort, the overall RARC PSM rate was 6%, and in patients with prostate surgery history it even was much higher to 14% [ 27 ]. Also, in a large multicenter report about PSM in radical cystectomy pointed that the PSM rate was 10.2% [ 28 ]. PSM could be related to many factors, including prostate surgery history, pelvic adhesion, or tumor metastasis which could not be identified before surgery [ 27 ].…”

Accurate Diagnosis and Survival Prediction of Bladder Cancer Using Deep Learning on Histological Slides

“…Mining of potentially robust clinical and/or biological features will aid in the diagnosis and risk stratification of BLCA patients to facilitate personalized treatment. A recent series of studies has explored the impact of immunohistochemical assays [ 30 ], conventional serum and histological biomarkers [ 31 , 32 , 33 , 34 , 35 ], and adjuvant therapy [ 36 , 37 ] on longitudinal monitoring and prognosis definition in BLCA patients. In this study, we utilized DL to develop a diagnostic model, BlcaMIL, and a prognostic model, MibcMLP, using WSIs for accurate diagnosis of BLCA and prognosis prediction of MIBC patients.…”

Long-Term Cardiovascular Mortality among 80,042 Older Patients with Bladder Cancer

“…Nonetheless, the key result in our study is a phenomenal description but not a causal result, while anticancer therapy, cardiovascular risk factors, and comorbidities were majorly associated with the causes of the phenomenon. The SEER database did not have data on residual disease and positive surgical margins’ locations, and we could not further explore their impact on CVD death risk in older BC patients [ 47 , 48 ].…”