title: Gender-specific differences in cancer-specific survival after radical cystectomy for patients with urothelial carcinoma of the urinary bladder in pathologic tumor stage T4a.
abstract: BACKGROUND
  Bladder cancer (UCB) staged pT4a show heterogeneous outcome after radical cystectomy (RC). No risk model has been established to date. Despite gender-specific differences, no comparative studies exist for this tumor stage.
  
  
  METHODS
  Cancer-specific survival (CSS) of 245 UCB patients without neoadjuvant chemotherapy staged pT4a, pN0-2, M0 after RC were analyzed in a retrospective multi-center study. Seventeen patients were excluded from further analysis due to carcinoma in situ (CIS) of the prostatic urethra and/or positive surgical margins. Average follow-up period was 30 months (IQR: 14-45). The influence of different clinical and histopathologic variables on CSS was determined through uni- and multivariate Cox regression analyses. Two risk groups were generated using factors with independent effect in multivariate models. Internal validity of the prediction model was evaluated by bootstrapping.
  
  
  RESULTS
  Eighty-four percent of the patients (n = 192) were male; 72% (n = 165) showed lymphovascular invasion (LVI). The 5-year CSS rate was 31%, and significantly different between male and female (35% vs. 15%, P = 0.003). Multivariate Cox regression modeling, female gender (HR = 1.83, P = 0.008), LVI (HR = 1.92, P = 0.005), and absence of adjuvant chemotherapy (HR = 0.61, P = 0.020) significantly worsened CSS. Two risk groups were generated using these 3 criteria, which differed significantly between each other in CSS (5-year-CSS: 46% vs. 12%, P < 0.001). The c-index value of the risk model was 0.61 (95% CI: 0.53-0.68, P < 0.001).
  
  
  CONCLUSIONS
  Prognosis in UCB staged pT4a is heterogeneous. Female gender and LVI are adverse factors. Adjuvant chemotherapy seems to improve outcome. The present analysis establishes the first risk model for this demanding tumor stage.
authors: Department of Urology, St. Elisabeth Klinikum, Straubing, Germany.
authors: Matthias
authors: M
authors: May
authors: Patrick J
authors: PJ
authors: Bastian
authors: Sabine
authors: S
authors: Brookman-May
authors: Hans-Martin
authors: HM
authors: Fritsche
authors: Derya
authors: D
authors: Tilki
authors: Wolfgang
authors: W
authors: Otto
authors: Christian
authors: C
authors: Bolenz
authors: Christian
authors: C
authors: Gilfrich
authors: Lutz
authors: L
authors: Trojan
authors: Edwin
authors: E
authors: Herrmann
authors: Rudolf
authors: R
authors: Moritz
authors: Arne
authors: A
authors: Tiemann
authors: Stefan C
authors: SC
authors: Müller
authors: Jörg
authors: J
authors: Ellinger
authors: Alexander
authors: A
authors: Buchner
authors: Christian G
authors: CG
authors: Stief
authors: Wolf F
authors: WF
authors: Wieland
authors: Thomas
authors: T
authors: Höfner
authors: Markus
authors: M
authors: Hohenfellner
authors: Axel
authors: A
authors: Haferkamp
authors: Jan
authors: J
authors: Roigas
authors: Mario
authors: M
authors: Zacharias
authors: Philipp
authors: P
authors: Nuhn
authors: Maximilian
authors: M
authors: Burger
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D001743:Urinary Bladder / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*