Preoperative plasma level of endoglin as a predictor for disease outcomes after radical cystectomy for nonmetastatic urothelial carcinoma of the bladder.

Elevated preoperative plasma level of endoglin has been associated with worse oncologic outcomes in various malignancies. The present large-scale study aimed to determine the predictive and prognostic values of preoperative endoglin with regard to clinicopathologic and survival outcomes in patients treated with radical cystectomy (RC) for nonmetastatic urothelial carcinoma of the bladder (UCB).  We prospectively collected preoperative blood samples from 1036 consecutive patients treated with RC for UCB. Logistic and Cox regression analyses were undertaken to assess the correlation of endoglin levels with pathologic and survival outcomes, respectively. The AUC and C-index were used to assess the discrimination. Patients with adverse pathologic features had significantly higher median preoperative endoglin plasma levels than their counterparts. Higher preoperative endoglin level was independently associated with an increased risk for lymph node metastasis, ≥pT3 disease, and nonorgan confined disease (NOCD; all p < 0.001). Plasma endoglin level was also independently associated with cancer-specific and overall survival in both pre- and postoperative models (all p < 0.05), as well as with recurrence-free survival (RFS) in the preoperative model (p < 0.001). The addition of endoglin to the preoperative standard model improved its discrimination for prediction of lymph node metastasis, ≥pT3 disease, NOCD, and RFS (differential increases in C-indices: 10%, 5%, 5.8%, and 4%, respectively). Preoperative plasma endoglin is associated with features of biologically and clinically aggressive UCB as well as survival outcomes. Therefore, it seems to hold the potential of identifying UCB patients who may benefit from intensified therapy in addition to RC such as extended lymphadenectomy or/and preoperative systemic therapy.

Molecular carcinogenesis. 2021 Sep 29 [Epub ahead of print]

Ekaterina Laukhtina, Victor M Schuettfort, David D Andrea, Benjamin Pradere, Keiichiro Mori, Fahad Quhal, Reza Sari Motlagh, Hadi Mostafaei, Satoshi Katayama, Nico С Grossmann, Pawel Rajwa, Flora Zeinler, Mohammad Abufaraj, Marco Moschini, Kristin Zimmermann, Pierre I Karakiewicz, Harun Fajkovic, Douglas Scherr, Eva Compérat, Peter Nyirady, Michael Rink, Dmitry Enikeev, Shahrokh F Shariat

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Special Surgery, Division of Urology, Jordan University Hospital, The University of Jordan, Amman, Jordan., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany., Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada., Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA., Department of Urology, Semmelweis University, Budapest, Hungary., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.