title: Characteristics and outcomes of patients with pT4 urothelial carcinoma at radical cystectomy: a retrospective international study of 583 patients.
abstract: OBJECTIVE
  We describe cancer specific outcomes in patients with pT4 bladder urothelial carcinoma at radical cystectomy in a large international cohort.
  
  
  METHODS
  We reviewed the records of 4,257 patients treated with radical cystectomy for bladder urothelial carcinoma at 12 centers. No patient received any preoperative systemic chemotherapy or radiotherapy.
  
  
  RESULTS
  Of the 4,257 patients 583 (14%) had pT4 bladder urothelial carcinoma, of whom 83.7% were male, 85.2% had substage pT4a disease, 24.9% had positive soft tissue surgical margins, 57.8% had lymphovascular invasion and 53.5% had lymph node metastasis. Median followup was 55.0 months. Overall estimated 5-year recurrence-free and cancer specific survival was 29% (95% CI 22-32) and 31% (95% CI 25-36), respectively. On multivariate analysis female gender (p = 0.005 and p = 0.001), positive soft tissue surgical margins (p = 0.014 and p <0.001), lymphovascular invasion (p = 0.016 and p = 0.005), pT4b substage (p = 0.041 and p = 0.002, respectively) and lymph node involvement (each p <0.001) were independently associated with disease recurrence and cancer specific mortality.
  
  
  CONCLUSIONS
  Patients with pT4 bladder urothelial carcinoma have highly variable outcomes. Features associated with metastatic tumor dissemination (ie lymph node invasion and lymphovascular invasion) and local disease burden (ie soft tissue surgical margins and pT4 substage) are associated with poor outcomes in patients with pT4 bladder urothelial carcinoma. Further research is needed to understand why female patients with pT4 bladder urothelial carcinoma have a worse outcome than their male counterparts.
authors: Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Munich, Germany.
authors: Derya
authors: D
authors: Tilki
authors: Robert S
authors: RS
authors: Svatek
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Hendrik
authors: H
authors: Isbarn
authors: Oliver
authors: O
authors: Reich
authors: Wassim
authors: W
authors: Kassouf
authors: Yves
authors: Y
authors: Fradet
authors: Giacomo
authors: G
authors: Novara
authors: Hans-Martin
authors: HM
authors: Fritsche
authors: Patrick J
authors: PJ
authors: Bastian
authors: Jonathan I
authors: JI
authors: Izawa
authors: Christian G
authors: CG
authors: Stief
authors: Vincenzo
authors: V
authors: Ficarra
authors: Seth P
authors: SP
authors: Lerner
authors: Mark
authors: M
authors: Schoenberg
authors: Colin P
authors: CP
authors: Dinney
authors: Eila
authors: E
authors: Skinner
authors: Yair
authors: Y
authors: Lotan
authors: Arthur I
authors: AI
authors: Sagalowsky
authors: Shahrokh F
authors: SF
authors: Shariat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult