title: Macroscopic, but not microscopic, perivesical fat invasion at radical cystectomy is an adverse predictor of recurrence and survival.
abstract: OBJECTIVE
  To examine whether the presence of microscopic (pT3a) or macroscopic (pT3b) disease worsens the prognosis relative to pT2 disease at radical cystectomy, as the prognostic significance of pT3a vs pT3b perivesical fat invasion (pT3) is controversial.
  
  
  METHODS
  In all, 242 patients with pT3 disease (pT3a in 88, pT3b in 121) had radical cystectomy and bilateral pelvic lymphadenectomy for transitional cell carcinoma of the urinary bladder; they were compared with 172 who had organ-confined muscle-invasive disease (pT2). For the analyses we used univariable and multivariable Cox regression models of recurrence and cancer-specific survival, adjusted for age, tumour grade, lymphovascular invasion and the presence of lymph node metastases.
  
  
  RESULTS
  In multivariable analyses, microscopic perivesical fat extension (pT3a) was not associated with higher recurrence (P = 0.3) or the mortality rate (P = 0.06) vs pT2 disease. Conversely, the presence of deep perivesical fat extension (pT3b) was associated with 1.8 times the rate of recurrence (P = 0.002) and with twice the rate of death (P = 0.001) vs pT2 disease.
  
  
  CONCLUSIONS
  These findings imply that a detailed assessment of the cystectomy specimen for the presence of microscopic perivesical fat invasion might not be necessary, as the presence of pT3a disease has no strong effect on recurrence or mortality. Moreover, patients with pT3a disease might not require more aggressive therapy than their counterparts with pT2 disease. However, further validation of our data is required.
authors.affiliation: The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: Ganesh S
authors.initials: GS
authors.lastname: Palapattu
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Amnon
authors.initials: A
authors.lastname: Vazina
authors.forename: Gilad E
authors.initials: GE
authors.lastname: Amiel
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
authors.forename: Mark P
authors.initials: MP
authors.lastname: Schoenberg
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery