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Prognostic value of computed tomography before radical cystectomy in patients with invasive bladder cancer: imaging predicts survival

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Abstract

Purpose

Computed tomography (CT) is current standard-of-care for preoperative staging in patients with invasive bladder cancer before radical cystectomy (RC). There are only sparse data on the association between preoperative CT findings and postoperative survival of patients.

Methods

We retrospectively evaluated preoperative CTs of 206 patients with invasive bladder cancer undergoing RC in an academic tertiary referral center. CTs were analyzed retrospectively for relative bladder wall thickness (BWT) and size of lymph nodes (LN). Associations between CT findings and risk of death from any cause (AC) as well as risk of death from bladder cancer (BC) were assessed by Kaplan–Meier estimates, cumulative incidence curves and multivariable Cox regression analysis.

Results

The median follow-up was 40 months. Increased BWT was significantly correlated with higher risk of death (AC: HR 1.68; p = 0.043; BC: HR 2.00; p = 0.027), as well as LN with a size of 6–10 mm (AC: HR 2.13; p = 0.002; BC: HR 2.77; p = 0.002) and >10 mm (AC: HR 2.47; p = 0.018; BC: HR 3.66; p = 0.007) when compared to LN ≤ 5 mm.

Conclusion

Our data showed a significant correlation of bladder wall thickness and LN size with the risk of death. Also lymph nodes >5 mm but ≤10 mm (resp. ≤8 mm)—usually considered non-pathologic—were associated with a significantly worse prognosis. This information can be used to counsel patients preoperatively. It might also be useful for a risk-adapted approach in regard to neoadjuvant chemotherapy.

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Author contributions

Project development: SCS, TZ, KH, JEG, MR, TM. Data collection: SCS, TZ, TH, IM, AKS. Data analysis: SCS, TZ, KH, BH, TH, TM. Manuscript writing: SCS, TZ, BH. Manuscript revision/editing: TH, KH, AKS, JEG, MR, TM. Statistical analysis: SCS, BH, IM.

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    Authors and Affiliations

    1. Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

      Sebastian Christoph Schmid, Thomas Horn, Ilja Metzger, Anna K. Seitz, Jürgen Erich Gschwend, Margitta Retz & Tobias Maurer

    2. Institute for Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

      Tina Zahel & Konstantin Holzapfel

    3. Institute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany

      Bernhard Haller

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    1. Sebastian Christoph Schmid
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    2. Tina Zahel
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    3. Bernhard Haller
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    4. Thomas Horn
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    8. Jürgen Erich Gschwend
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    9. Margitta Retz
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    10. Tobias Maurer
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    Correspondence to Sebastian Christoph Schmid.

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    The authors declare no conflict of interest.

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    The study was conducted according to local and national regulations and approved by the local ethics committee.

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    Sebastian Christoph Schmid and Tina Zahel have contributed equally to this work.

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    Schmid, S.C., Zahel, T., Haller, B. et al. Prognostic value of computed tomography before radical cystectomy in patients with invasive bladder cancer: imaging predicts survival. World J Urol 34, 569–576 (2016). https://doi.org/10.1007/s00345-015-1654-9

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    • DOI: https://doi.org/10.1007/s00345-015-1654-9

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