title: Outcome of patients with pathological tumor stage T3 urothelial carcinoma of the bladder following radical cystectomy in a single-center series with 116 patients.
abstract: OBJECTIVE
  Outcome prediction of pT3 urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) remains challenging. The objective of our study was to determine high-risk patients with poor survival outcome in a heterogeneous group substaged pT3 who might profit from early adjuvant chemotherapy.
  
  
  METHODS
  We compiled clinicopathological and immunohistochemical data of E-cadherin (E-cad) expression in 116 patients with pT3 UCB after RC in our single-center series. Multivariable Cox regression models including substaged pT3 established clinicopathological features, and the expression of the predictive immunohistochemical feature E-cad was used to identify independent predictors on progression-free (PFS), cancer-specific (CSS) and overall survival (OS), respectively.
  
  
  RESULTS
  No significant differences were found addressing clinicopathological data and substaged pT3. In multivariable Cox regression models, lymph node involvement was an independent predictor for PFS (p < 0.001), CSS (p < 0.001) and OS (p = 0.002), respectively. Lymphovascular invasion (LVI) significantly influenced PFS (p = 0.016). ASA score 3/4 independently predicted CSS (p = 0.049) and OS (p = 0.032). Neither pT3 substages nor E-cad expression were significant prognosticators for survival.
  
  
  CONCLUSIONS
  In pT3 UCB patients with ASA 3/4, positive lymph node status and/or presence of LVI, administration of chemotherapy should be considered due to the high risk of poor oncological outcome. The immunohistochemical marker E-cad was not an independent predictor.
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Breyer
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Otto
authors.forename: Johannes
authors.initials: J
authors.lastname: Bründl
authors.forename: Michael
authors.initials: M
authors.lastname: Gierth
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rößler
authors.forename: Wolf F
authors.initials: WF
authors.lastname: Wieland
authors.forename: Christian
authors.initials: C
authors.lastname: Giedl
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Hofstädter
authors.forename: Peter
authors.initials: P
authors.lastname: Rubenwolf
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD; D015820:Cadherins / Q000378:metabolism; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D019459:Urothelium / Q000601:surgery*
chemical_list: D015703:Antigens, CD; C513384:CDH1 protein, human; D015820:Cadherins