Positive surgical margins and their locations in specimens are adverse prognosis features after radical cystectomy in non-metastatic carcinoma invading bladder muscle: results from a nationwide case–control study
Correspondence: Yann Neuzillet, Department of Urology, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France.
What's known on the subject? and What does the study add?
- Positive surgical margin (PSM) frequency after radical cystectomy has been estimated to be 4–15%. Studies that have not distinguished between the different sites of PSM have failed to show that they are an independent prognostic factor for disease-free survival. Only perivesical soft tissue PSMs have been associated with an increased risk of cancer recurrence and cancer-specific death.
- This is the first comprehensive published analysis of PSMs occurring during radical cystectomy for pTx pN0 M0 bladder cancer according to their location, comparing their cancer-specific survival (CSS) and other outcomes with those of a control group paired according to TNM status, age, sex and urinary diversion method. Local recurrence-free survival rates were found to be lower in patients with both soft tissue and urethral PSMs. Moreover, soft-tissue PSMs were associated with lower metastatic recurrence-free and CSS rates.
- To compare the prognoses associated with positive surgical margins (PSMs) according to their urethral, ureteric and/or soft tissue locations in patients with pN0 M0 bladder cancer who have not undergone neoadjuvant chemotherapy.
Patients and Methods
- A retrospective, case–control study was conducted between 1991 and 2011 using data from 17 academic centres in France.
- A total of 154 patients (cases) with PSMs met the eligibility criteria and were matched according to centre, pT stage, gender, age and urinary diversion method with a population-based sample of 154 patients (controls) from 3651 patients who had undergone cystectomies.
- The median follow-up period was 23.9 months.
- Multivariable Cox regression analysis was used to test the effects of PSMs on local recurrence (LR)-free survival, metastatic recurrence (MR)-free survival and cancer-specific survival (CSS).
- The 5-year LR-free survival and CSS rates of patients with urethral and soft tissue PSMs were lower than those in the control group.
- A significant decrease in CSS was associated with soft tissue PSMs (P = 0.003, odds ratio = 0.425, 95% confidence interval 0.283–0.647). The prognosis was not affected in cases of ureteric PSMs.
- Soft tissue PSMs were associated with poor CSS rates in patients with pN0 M0 bladder cancer.
- A correlation between urethrectomy and a reduction of the risk of LR in a urethral PSM setting was observed.