title: Predictors of survival in patients with soft tissue surgical margin involvement at radical cystectomy.
abstract: BACKGROUND
  The presence of positive soft tissue surgical margins (STSM) at radical cystectomy (RC) is rare. Although some patients with STSM experience disease recurrence rapidly, some have long-term local disease control. We sought to describe the oncologic outcomes, identify predictors, and assess the impact of location and multifocality in patients with positive STSMs at RC.
  
  
  METHODS
  We retrospectively collected the data of 4,335 patients treated with RC and pelvic lymphadenectomy at 11 academic centers from 1981 to 2008. STSM was defined as the presence of tumor at inked areas of soft tissue on the RC specimen. Univariate and multivariate Cox regression models addressed recurrence-free survival and cancer-specific survival after surgery.
  
  
  RESULTS
  STSM were identified in 231 patients (5%). Actuarial recurrence-free survival estimates at 2 and 5 years after RC were 26 ± 3 and 21 ± 3%, respectively. Actuarial cancer-specific survival estimates at 2 and 5 years after RC were 33 ± 3 and 25 ± 4%, respectively. Higher body mass index (p = 0.050), higher tumor stage (p = 0.017), presence of grade 3 disease (p = 0.046), lymphovascular invasion (p = 0.003), and lymph node involvement (p = 0.003) were all independently associated with disease recurrence. Furthermore, higher tumor stage (p = 0.015), lymphovascular invasion (p = 0.006), and lymph node involvement (p = 0.006) were independently associated with cancer specific mortality. Location and multifocality of STSM were not associated with outcomes.
  
  
  CONCLUSIONS
  Although most patients with STSM at RC had poor outcomes, more than one-fifth had durable cancer control. Pathologic features associated with disease recurrence in the general RC population also stratify patients with STSM into differential risk groups.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. evanguelosxylinas@hotmail.com
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: David A
authors.initials: DA
authors.lastname: Green
authors.forename: Thomas
authors.initials: T
authors.lastname: Clozel
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillonneau
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Marek
authors.initials: M
authors.lastname: Babjuk
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Joual
authors.initials: J
authors.lastname: Abdennabi
authors.forename: Quoc D
authors.initials: QD
authors.lastname: Trinh
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.forename: Marc
authors.initials: M
authors.lastname: Zerbib
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality*; D008207:Lymphatic Metastasis; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery