title: Concomitant seminal vesicle invasion in pT4a urothelial carcinoma of the bladder with contiguous prostatic infiltration is an adverse prognosticator for cancer-specific survival after radical cystectomy.
abstract: OBJECTIVE
  To evaluate the prognostic value of concomitant seminal vesicle invasion (cSVI) in patients with urothelial carcinoma of the bladder (UCB) and contiguous prostatic stromal infiltration in a large cystectomy series.
  
  
  METHODS
  A total of 385 patients with UCB and contiguous prostatic infiltration comprised our study. Patients were divided in two groups according to cSVI. Median follow-up was 36 months (interquartile range 11-74); the primary end point was cancer-specific mortality. The prognostic impact of cSVI was evaluated using multivariable Cox regression analysis. The predictive accuracy was assessed by a receiver operating characteristic analysis.
  
  
  RESULTS
  A total of 229 patients (59.5 %) without cSVI comprised group A, and 156 patients (40.5 %) with cSVI comprised group B. Positive lymph nodes (63 vs. 44 %, p < 0.001) and positive surgical margins (34 % vs. 14 %, p < 0.001) were more common in patients with cSVI. The 5- and 10-year cancer-specific survival rates were 41 % and 32 % (group A) and 21 and 17 % (group B) (p < 0.001). In multivariable analysis, pathological nodal stage (hazard ratio [HR] 2.19, p < 0.001), soft tissue surgical margin (HR 1.57, p = 0.010), clinical tumor stage (HR 1.46, p = 0.010), adjuvant chemotherapy (HR 0.40, p < 0.001), and cSVI (HR 1.69, p < 0.001) independently impacted cancer-specific mortality. The c-indices of the multivariable models with and without inclusion of cSVI were 0.658 (95 % confidence interval 0.60-0.71) and 0.635 (95 % confidence interval 0.58-0.69), respectively, resulting in a predictive accuracy gain of 2.3 % (p = 0.002).
  
  
  CONCLUSIONS
  In patients with UCB and prostatic stromal invasion, cSVI adversely affected cancer-specific survival compared to patients without cSVI. The inclusion of cSVI significantly improved the predictive accuracy of our multivariable model regarding survival.
authors.affiliation: Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-May
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Christian
authors.initials: C
authors.lastname: Gilfrich
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
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: Florian
authors.initials: F
authors.lastname: Roghmann
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.forename: Roman
authors.initials: R
authors.lastname: Mayr
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novotny
authors.forename: Manfred
authors.initials: M
authors.lastname: Wirth
authors.forename: Stefan
authors.initials: S
authors.lastname: Vallo
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.forename: Antonin
authors.initials: A
authors.lastname: Brisuda
authors.forename: Regina
authors.initials: R
authors.lastname: Stredele
authors.forename: Björn
authors.initials: B
authors.lastname: Volkmer
authors.forename: Christopher
authors.initials: C
authors.lastname: Dechet
authors.forename: Marco
authors.initials: M
authors.lastname: Schnabel
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D012669:Seminal Vesicles / Q000473:pathology*; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery