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Concomitant Seminal Vesicle Invasion in pT4a Urothelial Carcinoma of the Bladder with Contiguous Prostatic Infiltration is an Adverse Prognosticator for Cancer-Specific Survival after Radical Cystectomy

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the prognostic value of concomitant seminal vesicle invasion (cSVI) in patients with urothelial carcinoma of the bladder (UCB) and contiguous prostatic stromal infiltration in a large cystectomy series.

Methods

A total of 385 patients with UCB and contiguous prostatic infiltration comprised our study. Patients were divided in two groups according to cSVI. Median follow-up was 36 months (interquartile range 11–74); the primary end point was cancer-specific mortality. The prognostic impact of cSVI was evaluated using multivariable Cox regression analysis. The predictive accuracy was assessed by a receiver operating characteristic analysis.

Results

A total of 229 patients (59.5 %) without cSVI comprised group A, and 156 patients (40.5 %) with cSVI comprised group B. Positive lymph nodes (63 vs. 44 %, p < 0.001) and positive surgical margins (34 % vs. 14 %, p < 0.001) were more common in patients with cSVI. The 5- and 10-year cancer-specific survival rates were 41 % and 32 % (group A) and 21 and 17 % (group B) (p < 0.001). In multivariable analysis, pathological nodal stage (hazard ratio [HR] 2.19, p < 0.001), soft tissue surgical margin (HR 1.57, p = 0.010), clinical tumor stage (HR 1.46, p = 0.010), adjuvant chemotherapy (HR 0.40, p < 0.001), and cSVI (HR 1.69, p < 0.001) independently impacted cancer-specific mortality. The c-indices of the multivariable models with and without inclusion of cSVI were 0.658 (95 % confidence interval 0.60–0.71) and 0.635 (95 % confidence interval 0.58–0.69), respectively, resulting in a predictive accuracy gain of 2.3 % (p = 0.002).

Conclusions

In patients with UCB and prostatic stromal invasion, cSVI adversely affected cancer-specific survival compared to patients without cSVI. The inclusion of cSVI significantly improved the predictive accuracy of our multivariable model regarding survival.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, St. Elisabeth Medical Center Straubing, Straubing, Germany

    Matthias May MD & Christian Gilfrich MD

  2. Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany

    Sabine Brookman-May MD & Christian G. Stief MD

  3. Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany

    Maximilian Burger MD, Hans-Martin Fritsche MD, Marco Schnabel MD & Stefan Denzinger MD

  4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Michael Rink MD, Felix Chun MD, Margit Fisch MD & Atiqullah Aziz MD

  5. Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany

    Florian Roghmann MD & Joachim Noldus MD

  6. Department of Urology, General Hospital of Bolzano, Bolzano, Italy

    Roman Mayr MD & Armin Pycha MD

  7. Department of Urology, University Hospital “Carl Gustav Carus”, Dresden Technical University, Dresden, Germany

    Vladimir Novotny MD & Manfred Wirth MD

  8. Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany

    Stefan Vallo MD & Axel Haferkamp MD

  9. Department of Urology, Vivantes Medical Center Im Friedrichshain and Am Urban, Berlin, Germany

    Jan Roigas MD

  10. Department of Urology, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic

    Antonin Brisuda MD

  11. Department of Urology, Kassel Medical Center, Kassel, Germany

    Regina Stredele MD & Björn Volkmer MD

  12. Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Christopher Dechet MD

  13. Department of Urology, Paracelsus Medical Center Golzheim, Düsseldorf, Germany

    Patrick J. Bastian MD

Authors
  1. Matthias May MD
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  2. Sabine Brookman-May MD
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  3. Maximilian Burger MD
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  4. Christian Gilfrich MD
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  5. Hans-Martin Fritsche MD
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  6. Michael Rink MD
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  7. Felix Chun MD
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  8. Margit Fisch MD
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  9. Florian Roghmann MD
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  10. Joachim Noldus MD
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  11. Roman Mayr MD
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  12. Armin Pycha MD
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  13. Vladimir Novotny MD
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  14. Manfred Wirth MD
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  15. Stefan Vallo MD
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  16. Axel Haferkamp MD
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  17. Jan Roigas MD
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  18. Antonin Brisuda MD
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  19. Regina Stredele MD
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  20. Björn Volkmer MD
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  21. Christopher Dechet MD
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  22. Marco Schnabel MD
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  23. Stefan Denzinger MD
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  24. Christian G. Stief MD
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  25. Patrick J. Bastian MD
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  26. Atiqullah Aziz MD
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Corresponding author

Correspondence to Atiqullah Aziz MD.

Additional information

Matthias May and Sabine Brookman-May contributed equally to this article, and both should be considered first author.

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May, M., Brookman-May, S., Burger, M. et al. Concomitant Seminal Vesicle Invasion in pT4a Urothelial Carcinoma of the Bladder with Contiguous Prostatic Infiltration is an Adverse Prognosticator for Cancer-Specific Survival after Radical Cystectomy . Ann Surg Oncol 21, 4034–4040 (2014). https://doi.org/10.1245/s10434-014-3827-y

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  • DOI: https://doi.org/10.1245/s10434-014-3827-y

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