Originally published as JCO Early Release 10.1200/JCO.2004.11.024 on June 15 2004

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Surgical Factors Influence Bladder Cancer Outcomes: A Cooperative Group Report

From the Memorial Sloan-Kettering Cancer Center, New York, NY; Southwest Oncology Group Statistical Center, Seattle, WA; University of Texas M.D. Anderson Cancer Center, Houston; University of Texas, San Antonio, TX; Salick Health Care, Los Angeles; University of California, Davis, CA; University of Colorado, Denver, CO

Address reprint requests to Southwest Oncology Group (SWOG-8710), Operations Office, 14980 Omicron Dr, San Antonio, TX 78245-3217; e-mail: bgranados{at}swog.org

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.

Supported in part by the following Public Health Service Cooperative Agreement grants awarded by the National Cancer Institute, Bethesda, MD: CA32102, CA38926, and CA42777.

Presented at the 39th Annual Meeting of the American Society of Clinical Oncology, June 2, 2003, Chicago, IL.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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