title: Positive surgical margins and their locations in specimens are adverse prognosis features after radical cystectomy in non-metastatic carcinoma invading bladder muscle: results from a nationwide case-control study.
abstract: OBJECTIVE
  To compare the prognoses associated with positive surgical margins (PSMs) according to their urethral, ureteric and/or soft tissue locations in patients with pN0 M0 bladder cancer who have not undergone neoadjuvant chemotherapy.
  
  
  METHODS
  A retrospective, case-control study was conducted between 1991 and 2011 using data from 17 academic centres in France. A total of 154 patients (cases) with PSMs met the eligibility criteria and were matched according to centre, pT stage, gender, age and urinary diversion method with a population-based sample of 154 patients (controls) from 3651 patients who had undergone cystectomies. The median follow-up period was 23.9 months. Multivariable Cox regression analysis was used to test the effects of PSMs on local recurrence (LR)-free survival, metastatic recurrence (MR)-free survival and cancer-specific survival (CSS).
  
  
  RESULTS
  The 5-year LR-free survival and CSS rates of patients with urethral and soft tissue PSMs were lower than those in the control group. A significant decrease in CSS was associated with soft tissue PSMs (P = 0.003, odds ratio = 0.425, 95% confidence interval 0.283-0.647). The prognosis was not affected in cases of ureteric PSMs.
  
  
  CONCLUSIONS
  Soft tissue PSMs were associated with poor CSS rates in patients with pN0 M0 bladder cancer. A correlation between urethrectomy and a reduction of the risk of LR in a urethral PSM setting was observed.
authors: Department of Urology, Hopital Foch, Universite De Versailles - Saint-Quentin En Yvelines, Suresnes, France. y.neuzillet@hopital-foch.org
authors: Yann
authors: Y
authors: Neuzillet
authors: Michel
authors: M
authors: Soulie
authors: Stéphane
authors: S
authors: Larre
authors: Morgan
authors: M
authors: Roupret
authors: Guillaume
authors: G
authors: Defortescu
authors: Thibaut
authors: T
authors: Murez
authors: Géraldine
authors: G
authors: Pignot
authors: Aurélien
authors: A
authors: Descazeaud
authors: Jean-Jacques
authors: JJ
authors: Patard
authors: Pierre
authors: P
authors: Bigot
authors: Laurent
authors: L
authors: Salomon
authors: Pierre
authors: P
authors: Colin
authors: Jérôme
authors: J
authors: Rigaud
authors: Cyrille
authors: C
authors: Bastide
authors: Xavier
authors: X
authors: Durand
authors: Antoine
authors: A
authors: Valeri
authors: François
authors: F
authors: Kleinclauss
authors: Franck
authors: F
authors: Bruyere
authors: Christian
authors: C
authors: Pfister
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016001:Confidence Intervals; D015653:Cystectomy / Q000379:methods*; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D001743:Urinary Bladder / Q000473:pathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery