Univariate and Multivariate Analysis of Pathological Prognostic Factors of Urothelial Bladder Cancer in Patients Undergoing Radical Cystectomy and LymphadenectomyEndric Hasegawa, Marcos Francisco Dall’Oglio*, Daniel Kanda Abe, Emanoela Batista Feitosa, Alexandre Crippa, José Pontes Junior and Miguel Srougi
Division of Urology of the University of São Paulo Medical School, Section of Uro-Oncology of the São Paulo State Cancer Institute, São Paulo/SP, Brazil
- *Corresponding Author:
- Marcos F Dall’Oglio
Rua Barata Ribeiro
398-5 andar, CEP 01308-000-São Paulo
E-mail: [email protected]
Received date October 11, 2012; Accepted date October 26, 2012; Published date October 28, 2012
Citation: Hasegawa E, Dall’Oglio MF, Abe DK, Feitosa EB, Crippa A, et al. (2012) Univariate and Multivariate Analysis of Pathological Prognostic Factors of Urothelial Bladder Cancer in Patients Undergoing Radical Cystectomy and Lymphadenectomy. Med Surg Urol 1:105. doi:10.4172/2168-9857.1000105
Copyright: © 2012 Hasegawa E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: To identify the most important pathologic prognostic factors for urothelial bladder cancer treated by radical cystectomy and pelvic lymphadenectomy in our institution. To analyze the impact of these factors on recurrence and mortality and suggest a group of factors that can predict the evolution after radical surgery.
Patients and methods: We review all cases of radical cystectomy and lymphadenectomy at the Clinical Hospital Medical School from 2006 to 2009. We study pathologic prognostic factors like tumor stage (pT), lympho-nodal metastasis (N+), lymphovascular invasion (LVI), perineural invasion (PNI) and presence of in situ carcinoma (CIS) and correlates with recurrence and mortality. The chi square, Fisher, log rank and cox regression models were used to determine the significance. We considered a significant association when p<0.05.
Results: From 166 cystectomies performed to treat urothelial bladder cancer, we selected 128 cases. There were 20 (15.6%) females and 108 (84.4%) males with ages ranging from 41 years to 84 years with an average 67 years old. Through univariate analyses, the recurrence was associated with tumor stage (pT) and lympho-nodal metastasis (N+) (p=0.032, p=0.003), but only the latter showed independence in multivariate analysis. (OR 3.2, p=0.003). The pT, N+, lymphovascular invasion (LVI) and perineural invasion (PNI) correlate with early general mortality. The univariate analysis presents the worst overall survival when PNI (p=0.01), pT > pT2 (p=0.001) and N+ (p=0.038). The Kaplan Meier curve found that pT>pT2, N+, LVI and PNI associated with reduced overall survival time. Specific survival time was influenced by pT>pT2 (p=0.001), LVI (p=0.038), N+ (p=0.034), and PNI (p=0.024). The multivariate analysis found that pT>pT2 is the most important prognostic factor associated with specific and overall survival (OR 4.44, p=0.002 and OR 4.28, p=0.001). The grouping of pT, N, LVI and PNI can easily and correct predict recurrence and mortality when compared with current nomograms.
Conclusion: The pathologic prognostic factors after radical cystectomy show that lymphatic metastasis (N+) has a strong association with recurrence and the tumor stage (pT) is a predictor for overall and specific survival. The combination of the factors pT, N, LVI and PNI can be compared to actual nomograms on evolution prediction.