title: Prognostic impact of infiltration of the vagina and/or uterus in women undergoing anterior pelvic exenteration for urothelial carcinoma of the bladder: results of a contemporary multicentre series.
abstract: OBJECTIVE
  To evaluate for the first time the prognostic significance of female invasive patterns in stage pT4a urothelial carcinoma of the bladder in a large series of women undergoing anterior pelvic exenteration.
  
  
  METHODS
  Our series comprised of 92 female patients in total of whom 87 with known invasion patterns were eligible for final analysis. Median follow-up for evaluation of cancer-specific mortality (CSM) was 38 months (interquartile ranges, 21-82 months). The impact on CSM was evaluated using multivariable Cox proportional-hazards regression analysis; predictive accuracy (PA) was assessed by receiver operating characteristic analysis.
  
  
  RESULTS
  Vaginal invasion was noted in 33 patients (37.9 %; group VAG), uterine invasion in 20 patients (23 %; group UT), and infiltration of both vagina and uterus in 34 patients (39.1 %; group VAG + UT). Groups VAG and UT significantly differed from group VAG + UT with regard to the presence of positive soft tissue margins (STM) only. Five-year-cancer-specific survival probabilities in the groups VAG, UT, and VAG + UT were 21, 20, and 21 %, respectively (p = 0.955). On multivariable analysis, only STM status (HR = 2.02, p = 0.023) independently influenced CSM. C-indices of multivariable models for CSM with and without integration of invasive patterns were 0.570 and 0.567, respectively (PA gain 0.3 %, p = 0.526).
  
  
  CONCLUSIONS
  Infiltration of the vagina, the uterus or both is associated with poor 5-year survival rates. With regard to CSM, no difference was detectable between patients with different invasion patterns, thus justifying further collectively including these invasive patterns as stage pT4a.
authors.affiliation: Department of Urology, St. Elisabeth Medical Centre Straubing, Straubing, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-May
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Felix
authors.initials: F
authors.lastname: Chun
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novotny
authors.forename: Manfred
authors.initials: M
authors.lastname: Wirth
authors.forename: Roman
authors.initials: R
authors.lastname: Mayr
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Antonin
authors.initials: A
authors.lastname: Brisuda
authors.forename: Björn
authors.initials: B
authors.lastname: Volkmer
authors.forename: Regina
authors.initials: R
authors.lastname: Stredele
authors.forename: Christopher
authors.initials: C
authors.lastname: Dechet
authors.forename: Stefan
authors.initials: S
authors.lastname: Vallo
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
authors.forename: Marco
authors.initials: M
authors.lastname: Schnabel
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Christian
authors.initials: C
authors.lastname: Gilfrich
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Jörg B
authors.initials: JB
authors.lastname: Engel
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000556:secondary*; D014625:Vaginal Neoplasms / Q000453:epidemiology / Q000556:secondary*