SIU 2017: Impact of Positive Surgical Margin on the Outcome of Radical Cystectomy for Urothelial Cell Carcinoma

Lisbon, Portugal ( Radical cystectomy (RC) is a morbid operation with variable outcomes. There are conflicting data regarding the association between positive surgical margins (PSM) and survival outcomes. In this study the authors evaluated the association of PSM with outcomes of RC due to urothelial cell carcinoma (UCC) within a single centre.

The authors established a prospective database in 1994 which included consecutive patients who underwent a radical cystectomy (RC) between 1994 and 2016 within a single centre.

A total of 1279 RC were performed, out of which 1110 were performed due to UCC. 85 (7.7%) RC specimens revealed a PSM (ureteric/urethral, n=31; circumferential, n=32; and both n=22). The Median (IQR) follow-up was 17.2 (9.0-30.4) and 30.3 (12.4-59.0) months for PSM and negative surgical margin (NSM) groups respectively. The overall survival (OS) in the PSM and NSM group was 67.1% and 40.0% (Chi-square p<0.001) respectively, and for disease-specific morality (DSM), 56.5%and 26.1% (p<0.001) respectively. Kaplan-Meier analysis demonstrated a 5-year DSM of 32.5% with PSM (vs NSM 65.7%, log-rank p<0.001). Within PSM, the 5-year survival for circumferential PSM was 6.7% and 78.2% for ureteric/urethral PSM (log-rank p<0.001). Positive surgical margin was an independent predictor of OS (HR 2.27, p<0.001) and DSM (HR 2.90, p<0.001). On univariate analysis patients with poor survival in the PSM group was associated with age, female gender, transurethral resection >pT2, pTis, RC >pT2, M1 + and a circumferential PSM.

The authors concluded that PSM, in particular circumferential PSM, is associated with poorer OS and DSM. Therefore avoidance of PSM in RC is critical for cancer specific and overall survival.

Presented by: Pang KH
Affiliation: Dept. of Oncology and Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal