Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients.
OBJECTIVE
We evaluated the association of soft tissue surgical margins with characteristics and outcomes of patients treated with radical cystectomy for urothelial carcinoma of the bladder.


METHODS
We retrospectively collected the data of 4,410 patients treated with radical cystectomy and pelvic lymphadenectomy without neoadjuvant chemotherapy at 12 academic centers in the United States, Canada and Europe. A positive soft tissue surgical margin was defined as presence of tumor at inked areas of soft tissue on the radical cystectomy specimen.


RESULTS
Positive soft tissue surgical margins were identified in 278 patients (6.3%). On univariate analysis positive soft tissue surgical margin was significantly associated with advanced pT stage, higher tumor grade, lymphovascular invasion and lymph node metastasis (p <0.001). Actuarial 5-year recurrence-free and cancer specific survival probabilities were 62.8% +/- 0.8% and 69% +/- 0.8% for patients without soft tissue surgical margins vs 21.6% +/- 3.1% and 26.4% +/- 3.3% for those with positive soft tissue surgical margins (p <0.001). On multivariable analyses adjusting for the effect of standard clinicopathological features and adjuvant chemotherapy positive soft tissue surgical margin was an independent predictor of disease recurrence and cancer specific mortality (HR 1.52 and HR 1.51, p <0.001, respectively). Soft tissue surgical margin retained independent predictive value in subgroups with advanced disease such as pT3Nany, pT4Nany or Npositive.


CONCLUSIONS
Positive soft tissue surgical margin is a strong predictor of recurrence and eventual death from urothelial carcinoma of the bladder. Soft tissue surgical margin status should always be reported in the pathological reports after radical cystectomy. Due to uniformly poor outcomes patients with positive soft tissue surgical margins should be considered for studies on adjuvant local and/or systemic therapy.
Novara
Giacomo
G
University of Padua, Padua, Italy.
Svatek
Robert S
RS
Karakiewicz
Pierre I
PI
Skinner
Eila
E
Ficarra
Vincenzo
V
Fradet
Yves
Y
Lotan
Yair
Y
Isbarn
Hendrik
H
Capitanio
Umberto
U
Bastian
Patrick J
PJ
Kassouf
Wassim
W
Fritsche
Hans-Martin
HM
Izawa
Jonathan I
JI
Tilki
Derya
D
Dinney
Colin P
CP
Lerner
Seth P
SP
Schoenberg
Mark
M
Volkmer
Bjoern G
BG
Sagalowsky
Arthur I
AI
Shariat
Shahrokh F
SF
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*