Article
Prognostic impact of tumor-associated round cell infiltrates at radical cystectomy for bladder cancer
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Authors
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Tina Schubert
- Uniklinik Würzburg
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Fahmy Hassan
- Uniklinik Würzburg
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Manuel Alexander Schmid
- Uniklinik Würzburg
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Markus Renninger
- Uniklinik Würzburg
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Arnulf Stenzl
- Uniklinik Würzburg
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Hubert Kübler
- Uniklinik Würzburg
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Georgios Gakis
- Uniklinik Würzburg
| Published: | May 17, 2018 |
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Outline
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Objectives: To assess whether the presence of tumor-associated round cell infiltrates (TARCs) on histological slides obtained from cystectomy specimens impacts on oncological outcomes of patients with bladder cancer (BC). Material and
Methods: A total of 329 consecutive patients staged cM0 BC underwent radical cystectomy (RC) between 2002 and 2013. The presence of TARCs (either located peritumorally (PRCs) and/or intratumorally (IRCs)) on histological slides was retrospectively assessed and correlated with outcomes. Kaplan-Meier analysis was used to estimate the impact of TARCs on recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS). Multivariable Cox-regression analysis was carried out to assess risk factors of recurrence. The median follow-up for was 36 months (interquartile range: 9-54).
Results: Of the 329 patients, 43 (13.1%) exhibited IRCs, 146 (44.4%) PRCs and 140 (42.6%) no TARCs in the cystectomy specimens. Absence of TARCs was associated with higher age (p=0.045) and ECOG performance status (p=0.039), histologically advanced tumor stage (pT3a; p<0.001), lymph node tumor involvement (pN+; p=0.021), positive surgical margins (p=0.007), lymphovascular invasion (p<0.001) and elevated serum CRP levels (p<0.001) whereas a lower rate of tumor multifocality was observed in patients with absence of TARCs (p=0.044). The 3-year RFS/CSS/OS was 74.6%/88.9%/77.3% for patients with IRCs, 68.2%/84.6%/70.7% for PRCs and 47.6%/68.2%/54.7% for patients without TARCs (p=0.001/<0.001/<0.001 for TARCs vs. no TARCs). In multivariable analysis, adjusted for all significant parameters of univariable analysis, histologically advanced tumor stage (p=0.020), node-positive disease (p=0.009) and the absence of TARCs (p=0.033) were independent prognosticators for recurrence.
Conclusions: The presence of TARCs in cystectomy specimens is a strong prognosticator for improved RFS after RC. This finding suggests that the local activity of the immune system is important for effective bladder cancer control in invasive disease.
