Surgical Factors Influence Bladder Cancer Outcomes: A Cooperative Group Report

Abstract

Purpose A randomized, cooperative group trial (Southwest Oncology Group 8710, Intergroup 0080) reported that neoadjuvant chemotherapy improved the survival of patients with locally advanced bladder cancer who were treated with radical cystectomy. We evaluated whether surgical factors from patients enrolled onto the study predicted bladder cancer outcomes. Patients and Methods Surgical and tumor factors were recorded from surgical and pathologic reports from 268 patients with muscle-invasive bladder cancer who received radical cystectomy. Cystectomies were performed by 106 surgeons in 109 institutions. Half of the patients received neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy. Variables were tested in univariate and multivariate analyses for associations with postcystectomy survival (PCS) and local recurrence (LR) in all patients receiving cystectomy. Results Five-year PCS and LR rates were 54% and 15%, respectively. A multivariate model adjusted for MVAC (P = .97), age (P = .03), pathologic stage (P = .0002), and node status (P = .04) showed that surgical variables associated with longer PCS were negative margins (v positive; hazard ratio [HR], 0.37; P = .0007), and ≥ 10 nodes removed (v < 10; HR, 0.51; P = .0001). These associations did not differ by treatment arms (P > .21 for all tests of interactions between treatment and surgical variables). Predictors of LR in a multivariate model adjusted for MVAC (P = .16), pathologic stage (P = .02), and node status (P = .37) were positive margins (v negative; odds ratio [OR], 11.2; P = .0001) and fewer than 10 nodes removed (v ≥ 10; OR, 5.1; P = .002). Conclusion Surgical factors influence bladder cancer outcomes after cystectomy, after adjustment for pathologic factors and neoadjuvant chemotherapy usage.