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.
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.
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).
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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Witjes JA, Compérat E, Cowan NC, et al. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol. 2014;65:778–92.
Niegisch G, Albers P. Which patients benefit the most from neoadjuvant chemotherapy in advanced bladder cancer? Curr Opin Urol. 2011;21:434–9.
Feifer AH, Taylor JM, Tarin TV, Herr HW. Maximizing cure for muscle-invasive bladder cancer: integration of surgery and chemotherapy. Eur Urol. 2011;59:978–84.
Nuhn P, May M, Sun M, et al. External validation of postoperative nomograms for prediction of all-cause mortality, cancer-specific mortality, and recurrence in patients with urothelial carcinoma of the bladder. Eur Urol. 2012;61:58–64.
Tilki D, Svatek RS, Karakiewicz PI, et al. Characteristics and outcomes of patients with pT4 urothelial carcinoma at radical cystectomy: a retrospective international study of 583 patients. J Urol. 2010;183:1757–63.
Liberman D, Alasker A, Sun M, et al. Radical cystectomy for patients with pT4 urothelial carcinoma in a large population-based study. BJU Int. 2011;107:905–11.
Greene FL, Gospodarowicz M, Wittekend C. American Joint Committee on Cancer (AJCC) staging manual. 7th ed. Philadalphia: Springer; 2009.
Volkmer BG, Küfer R, Maier S, et al. Outcome in patients with seminal vesicle invasion after radical cystectomy. J Urol. 2003;169:1299–302.
Daneshmand S, Stein JP, Lesser T, et al. Prognosis of seminal vesicle involvement by transitional cell carcinoma of the bladder. J Urol. 2004;172:81–4.
You D, Kim SC, Jeong IG, et al. Urothelial carcinoma of the bladder with seminal vesicle invasion: prognostic significance. BJU Int. 2010;106:1657–61.
Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.
May M, Bastian PJ, Brookman-May S, et al. Gender-specific differences in cancer-specific survival after radical cystectomy for patients with urothelial carcinoma of the urinary bladder in pathologic tumor stage T4a. Urol Oncol. 2011;31:1141–7.
Donat SM, Genega EM, Herr HW, Reuter VE. Mechanisms of prostatic stromal invasion in patients with bladder cancer: clinical significance. J Urol. 2001;165:1117–20.
Ro JY, Ayala AG, el-Naggar A, Wishnow KI. Seminal vesicle involvement by in situ and invasive transitional cell carcinoma of the bladder. Am J Surg Pathol. 1987;11:951–8.
Montie JE, Wojno K, Klein E, Pearsall C, Levin H. Transitional cell carcinoma in situ of the seminal vesicles: 8 cases with discussion of pathogenesis, and clinical and biological implications. J Urol. 1997;158:1895–8.
The authors declare no conflict of interest.
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
- Radical Cystectomy
- Seminal Vesicle Invasion
- Invasion Pattern
- Clinical Tumor Stage
- Prostatic Stroma