Comparative analysis of the effect of prostatic invasion patterns on cancer-specific mortality after radical cystectomy in pT4a urothelial carcinoma of the bladder.
To evaluate the prognostic relevance of different prostatic invasion patterns in pT4a urothelial carcinoma of the bladder (UCB) after radical cystectomy.



Our study comprised a total of 358 men with pT4a UCB. Patients were divided in 2 groups-group A with stromal infiltration of the prostate via the prostatic urethra with additional muscle-invasive UCB (n = 121, 33.8%) and group B with continuous infiltration of the prostate through the entire bladder wall (n = 237, 66.2%). The effect of age, tumor grade, carcinoma in situ, lymphovascular invasion, soft tissue surgical margin, lymph node metastases, administration of adjuvant chemotherapy, and prostatic invasion patterns on cancer-specific mortality (CSM) was evaluated using competing-risk regression analysis. Decision curve analysis was used to evaluate the net benefit of including the variable invasion pattern within our model.



The estimated 5-year CSM-rates for group A and B were 50.1% and 66.0%, respectively. In multivariable competing-risk analysis, lymph node metastases (hazard ratio [HR] = 1.73, P<0.001), lymphovascular invasion (HR = 1.62, P = 0.0023), soft tissue surgical margin (HR = 1.49, P = 0.026), absence of adjuvant chemotherapy (HR = 2.11, P<0.001), and tumor infiltration of the prostate by continuous infiltration of the entire bladder wall (HR = 1.37, P = 0.044) were significantly associated with a higher risk for CSM. Decision curve analysis showed a net benefit of our model including the variable invasion pattern.



Continuous infiltration of the prostate through the entire bladder wall showed an adverse effect on CSM. Besides including these patients into clinical trials for an adjuvant therapy, we recommend including prostatic invasion patterns in predictive models in pT4a UCB in men.
Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany. Electronic address: stefanvallo@gmx.de.
Stefan
S
Vallo
Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany.
Christian
C
Gilfrich
Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
Maximilian
M
Burger
Department of Urology, Kassel Medical Center, Kassel, Germany.
Björn
B
Volkmer
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Katharina
K
Boehm
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Michael
M
Rink
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Felix K
FK
Chun
Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
Florian
F
Roghmann
Department of Urology, University Hospital Carl Gustav Carus, Dresden Technical University, Dresden, Germany.
Vladimir
V
Novotny
Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany.
Jens
J
Mani
Department of Urology, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
Antonin
A
Brisuda
Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Department of Urology, General Hospital of Bolzano, Bolzano, Italy.
Roman
R
Mayr
Department of Urology, Kassel Medical Center, Kassel, Germany.
Regina
R
Stredele
Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
Joachim
J
Noldus
Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
Marco
M
Schnabel
Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany.
Matthias
M
May
Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
Hans-Martin
HM
Fritsche
Department of Urology, General Hospital of Bolzano, Bolzano, Italy.
Armin
A
Pycha
Department of Urology, General Hospital of Bolzano, Bolzano, Italy; Department of Urology, University Hospital Mannheim, Mannheim, Germany.
Thomas
T
Martini
Department of Urology, University Hospital Carl Gustav Carus, Dresden Technical University, Dresden, Germany.
Manfred
M
Wirth
Department of Urology, Vivantes Medical Center Im Friedrichshain and Am Urban, Berlin, Germany.
Jan
J
Roigas
Department of Urology, Marien Hospital Düsseldorf, Düsseldorf, Germany.
Patrick J
PJ
Bastian
Department of Urology, University Hospital Mannheim, Mannheim, Germany.
Philipp
P
Nuhn
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Roland
R
Dahlem
Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany.
Axel
A
Haferkamp
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Margit
M
Fisch
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Atiqullah
A
Aziz
D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D006801:Humans; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology*; D012307:Risk Factors; D015996:Survival Rate; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy
Bladder cancer; Mortality; Outcome; Prostatic invasion pattern; Radical cystectomy