Predictors of survival in patients with soft tissue surgical margin involvement at radical cystectomy

Evanguelos Xylinas, Michael Rink, Giacomo Novara, David A. Green, Thomas Clozel, Hans Martin Fritsche, Bertrand Guillonneau, Yair Lotan, Wassim Kassouf, Derya Tilki, Marek Babjuk, Pierre I. Karakiewicz, Francesco Montorsi, Joual Abdennabi, Quoc D. Trinh, Robert S. Svatek, Douglas S. Scherr, Marc Zerbib, Shahrokh F. Shariat

Research output: Contribution to journalArticle

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Abstract

Background: The presence of positive soft tissue surgical margins (STSM) at radical cystectomy (RC) is rare. Although some patients with STSM experience disease recurrence rapidly, some have long-term local disease control. We sought to describe the oncologic outcomes, identify predictors, and assess the impact of location and multifocality in patients with positive STSMs at RC. Methods: We retrospectively collected the data of 4,335 patients treated with RC and pelvic lymphadenectomy at 11 academic centers from 1981 to 2008. STSM was defined as the presence of tumor at inked areas of soft tissue on the RC specimen. Univariate and multivariate Cox regression models addressed recurrence-free survival and cancer-specific survival after surgery. Results: STSM were identified in 231 patients (5 %). Actuarial recurrence-free survival estimates at 2 and 5 years after RC were 26 ± 3 and 21 ± 3 %, respectively. Actuarial cancer-specific survival estimates at 2 and 5 years after RC were 33 ± 3 and 25 ± 4 %, respectively. Higher body mass index (p = 0.050), higher tumor stage (p = 0.017), presence of grade 3 disease (p = 0.046), lymphovascular invasion (p = 0.003), and lymph node involvement (p = 0.003) were all independently associated with disease recurrence. Furthermore, higher tumor stage (p = 0.015), lymphovascular invasion (p = 0.006), and lymph node involvement (p = 0.006) were independently associated with cancer specific mortality. Location and multifocality of STSM were not associated with outcomes. Conclusions: Although most patients with STSM at RC had poor outcomes, more than one-fifth had durable cancer control. Pathologic features associated with disease recurrence in the general RC population also stratify patients with STSM into differential risk groups.

Original languageEnglish (US)
Pages (from-to)1027-1034
Number of pages8
JournalAnnals of Surgical Oncology
Volume20
Issue number3
DOIs
StatePublished - Mar 2013

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Cystectomy
Survival
Recurrence
Neoplasms
Lymph Nodes
Margins of Excision
Lymph Node Excision
Proportional Hazards Models
Body Mass Index
Mortality
Population

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Xylinas, E., Rink, M., Novara, G., Green, D. A., Clozel, T., Fritsche, H. M., ... Shariat, S. F. (2013). Predictors of survival in patients with soft tissue surgical margin involvement at radical cystectomy. Annals of Surgical Oncology, 20(3), 1027-1034. https://doi.org/10.1245/s10434-012-2708-5

Predictors of survival in patients with soft tissue surgical margin involvement at radical cystectomy. / Xylinas, Evanguelos; Rink, Michael; Novara, Giacomo; Green, David A.; Clozel, Thomas; Fritsche, Hans Martin; Guillonneau, Bertrand; Lotan, Yair; Kassouf, Wassim; Tilki, Derya; Babjuk, Marek; Karakiewicz, Pierre I.; Montorsi, Francesco; Abdennabi, Joual; Trinh, Quoc D.; Svatek, Robert S.; Scherr, Douglas S.; Zerbib, Marc; Shariat, Shahrokh F.

In: Annals of Surgical Oncology, Vol. 20, No. 3, 03.2013, p. 1027-1034.

Research output: Contribution to journalArticle

Xylinas, E, Rink, M, Novara, G, Green, DA, Clozel, T, Fritsche, HM, Guillonneau, B, Lotan, Y, Kassouf, W, Tilki, D, Babjuk, M, Karakiewicz, PI, Montorsi, F, Abdennabi, J, Trinh, QD, Svatek, RS, Scherr, DS, Zerbib, M & Shariat, SF 2013, 'Predictors of survival in patients with soft tissue surgical margin involvement at radical cystectomy', Annals of Surgical Oncology, vol. 20, no. 3, pp. 1027-1034. https://doi.org/10.1245/s10434-012-2708-5
Xylinas, Evanguelos ; Rink, Michael ; Novara, Giacomo ; Green, David A. ; Clozel, Thomas ; Fritsche, Hans Martin ; Guillonneau, Bertrand ; Lotan, Yair ; Kassouf, Wassim ; Tilki, Derya ; Babjuk, Marek ; Karakiewicz, Pierre I. ; Montorsi, Francesco ; Abdennabi, Joual ; Trinh, Quoc D. ; Svatek, Robert S. ; Scherr, Douglas S. ; Zerbib, Marc ; Shariat, Shahrokh F. / Predictors of survival in patients with soft tissue surgical margin involvement at radical cystectomy. In: Annals of Surgical Oncology. 2013 ; Vol. 20, No. 3. pp. 1027-1034.
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abstract = "Background: The presence of positive soft tissue surgical margins (STSM) at radical cystectomy (RC) is rare. Although some patients with STSM experience disease recurrence rapidly, some have long-term local disease control. We sought to describe the oncologic outcomes, identify predictors, and assess the impact of location and multifocality in patients with positive STSMs at RC. Methods: We retrospectively collected the data of 4,335 patients treated with RC and pelvic lymphadenectomy at 11 academic centers from 1981 to 2008. STSM was defined as the presence of tumor at inked areas of soft tissue on the RC specimen. Univariate and multivariate Cox regression models addressed recurrence-free survival and cancer-specific survival after surgery. Results: STSM were identified in 231 patients (5 {\%}). Actuarial recurrence-free survival estimates at 2 and 5 years after RC were 26 ± 3 and 21 ± 3 {\%}, respectively. Actuarial cancer-specific survival estimates at 2 and 5 years after RC were 33 ± 3 and 25 ± 4 {\%}, respectively. Higher body mass index (p = 0.050), higher tumor stage (p = 0.017), presence of grade 3 disease (p = 0.046), lymphovascular invasion (p = 0.003), and lymph node involvement (p = 0.003) were all independently associated with disease recurrence. Furthermore, higher tumor stage (p = 0.015), lymphovascular invasion (p = 0.006), and lymph node involvement (p = 0.006) were independently associated with cancer specific mortality. Location and multifocality of STSM were not associated with outcomes. Conclusions: Although most patients with STSM at RC had poor outcomes, more than one-fifth had durable cancer control. Pathologic features associated with disease recurrence in the general RC population also stratify patients with STSM into differential risk groups.",
author = "Evanguelos Xylinas and Michael Rink and Giacomo Novara and Green, {David A.} and Thomas Clozel and Fritsche, {Hans Martin} and Bertrand Guillonneau and Yair Lotan and Wassim Kassouf and Derya Tilki and Marek Babjuk and Karakiewicz, {Pierre I.} and Francesco Montorsi and Joual Abdennabi and Trinh, {Quoc D.} and Svatek, {Robert S.} and Scherr, {Douglas S.} and Marc Zerbib and Shariat, {Shahrokh F.}",
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T1 - Predictors of survival in patients with soft tissue surgical margin involvement at radical cystectomy

AU - Xylinas, Evanguelos

AU - Rink, Michael

AU - Novara, Giacomo

AU - Green, David A.

AU - Clozel, Thomas

AU - Fritsche, Hans Martin

AU - Guillonneau, Bertrand

AU - Lotan, Yair

AU - Kassouf, Wassim

AU - Tilki, Derya

AU - Babjuk, Marek

AU - Karakiewicz, Pierre I.

AU - Montorsi, Francesco

AU - Abdennabi, Joual

AU - Trinh, Quoc D.

AU - Svatek, Robert S.

AU - Scherr, Douglas S.

AU - Zerbib, Marc

AU - Shariat, Shahrokh F.

PY - 2013/3

Y1 - 2013/3

N2 - Background: The presence of positive soft tissue surgical margins (STSM) at radical cystectomy (RC) is rare. Although some patients with STSM experience disease recurrence rapidly, some have long-term local disease control. We sought to describe the oncologic outcomes, identify predictors, and assess the impact of location and multifocality in patients with positive STSMs at RC. Methods: We retrospectively collected the data of 4,335 patients treated with RC and pelvic lymphadenectomy at 11 academic centers from 1981 to 2008. STSM was defined as the presence of tumor at inked areas of soft tissue on the RC specimen. Univariate and multivariate Cox regression models addressed recurrence-free survival and cancer-specific survival after surgery. Results: STSM were identified in 231 patients (5 %). Actuarial recurrence-free survival estimates at 2 and 5 years after RC were 26 ± 3 and 21 ± 3 %, respectively. Actuarial cancer-specific survival estimates at 2 and 5 years after RC were 33 ± 3 and 25 ± 4 %, respectively. Higher body mass index (p = 0.050), higher tumor stage (p = 0.017), presence of grade 3 disease (p = 0.046), lymphovascular invasion (p = 0.003), and lymph node involvement (p = 0.003) were all independently associated with disease recurrence. Furthermore, higher tumor stage (p = 0.015), lymphovascular invasion (p = 0.006), and lymph node involvement (p = 0.006) were independently associated with cancer specific mortality. Location and multifocality of STSM were not associated with outcomes. Conclusions: Although most patients with STSM at RC had poor outcomes, more than one-fifth had durable cancer control. Pathologic features associated with disease recurrence in the general RC population also stratify patients with STSM into differential risk groups.

AB - Background: The presence of positive soft tissue surgical margins (STSM) at radical cystectomy (RC) is rare. Although some patients with STSM experience disease recurrence rapidly, some have long-term local disease control. We sought to describe the oncologic outcomes, identify predictors, and assess the impact of location and multifocality in patients with positive STSMs at RC. Methods: We retrospectively collected the data of 4,335 patients treated with RC and pelvic lymphadenectomy at 11 academic centers from 1981 to 2008. STSM was defined as the presence of tumor at inked areas of soft tissue on the RC specimen. Univariate and multivariate Cox regression models addressed recurrence-free survival and cancer-specific survival after surgery. Results: STSM were identified in 231 patients (5 %). Actuarial recurrence-free survival estimates at 2 and 5 years after RC were 26 ± 3 and 21 ± 3 %, respectively. Actuarial cancer-specific survival estimates at 2 and 5 years after RC were 33 ± 3 and 25 ± 4 %, respectively. Higher body mass index (p = 0.050), higher tumor stage (p = 0.017), presence of grade 3 disease (p = 0.046), lymphovascular invasion (p = 0.003), and lymph node involvement (p = 0.003) were all independently associated with disease recurrence. Furthermore, higher tumor stage (p = 0.015), lymphovascular invasion (p = 0.006), and lymph node involvement (p = 0.006) were independently associated with cancer specific mortality. Location and multifocality of STSM were not associated with outcomes. Conclusions: Although most patients with STSM at RC had poor outcomes, more than one-fifth had durable cancer control. Pathologic features associated with disease recurrence in the general RC population also stratify patients with STSM into differential risk groups.

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