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.

Urologic oncology. 2016 Jun 06 [Epub ahead of print]

Stefan Vallo, Christian Gilfrich, Maximilian Burger, Björn Volkmer, Katharina Boehm, Michael Rink, Felix K Chun, Florian Roghmann, Vladimir Novotny, Jens Mani, Antonin Brisuda, Roman Mayr, Regina Stredele, Joachim Noldus, Marco Schnabel, Matthias May, Hans-Martin Fritsche, Armin Pycha, Thomas Martini, Manfred Wirth, Jan Roigas, Patrick J Bastian, Philipp Nuhn, Roland Dahlem, Axel Haferkamp, Margit Fisch, Atiqullah Aziz

Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany. Electronic address: ., Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany., Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany., Department of Urology, Kassel Medical Center, Kassel, Germany., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., Department of Urology, University Hospital Carl Gustav Carus, Dresden Technical University, Dresden, Germany., Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany., Department of Urology, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic., Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Department of Urology, General Hospital of Bolzano, Bolzano, Italy., Department of Urology, Kassel Medical Center, Kassel, Germany., Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany., Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany., Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany., Department of Urology, General Hospital of Bolzano, Bolzano, Italy., Department of Urology, General Hospital of Bolzano, Bolzano, Italy; Department of Urology, University Hospital Mannheim, Mannheim, Germany., Department of Urology, University Hospital Carl Gustav Carus, Dresden Technical University, Dresden, Germany., Department of Urology, Vivantes Medical Center Im Friedrichshain and Am Urban, Berlin, Germany., Department of Urology, Marien Hospital Düsseldorf, Düsseldorf, Germany., Department of Urology, University Hospital Mannheim, Mannheim, Germany., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

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