Article
Prognostic significance of previous tonsillectomy after 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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Purpose: There is increasing evidence which suggests that the integrity of the immune system influences survival of patients with advanced bladder cancer (BC). In this regard, it can be hypothesized that the removal of the tonsils may exert an impact on the long-term immune function. The aim of this analysis was to examine whether previous tonsillectomy impacts on survival after radical cystectomy (RC) for BC.
Material and methods: A total of 329 patients were staged cM0 and underwent RC for BC between 2002–2013. We retrospectively investigated whether patients had undergone tonsillectomy prior to RC. Univariable analysis with Chi-Square Test/Fisher-Exact Test was carried out to investigate clinical and pathological parameters associated with a history of tonsillectomy prior to RC. Kaplan-Meier analysis was used to estimate recurrence-free survival (RFS) and multivariable Cox-regression analysis of risk factors of recurrence. The median follow-up for recurrence was 31 months (interquartile range: 5-48).
Results: A history of tonsillectomy was present in 18 of the 329 patients (5.5%). Tonsillectomy prior to RC was associated with tumor multifocality (p<0.001), receipt of palliative chemotherapy (p=0.005), advanced histopathological tumor stage (p=0.014), non-pure urothelial carcinoma (p=0.023), lymphovascular invasion (p=0.035), lower age at RC (p=0.036) and a positive history of appendectomy (p=0.042). The 3-year RFS was 39.2% for patients with previous tonsillectomy and 62.0% for those without (p=0.009). In multivariable analysis, adjusted for all significant parameters of univariable analysis, lymph-node tumor involvement (p=0.008), positive surgical margins (p=0.010), tumor grade (p=0.034), advanced tumor stage (pT3a; p=0.035) and a history of previous tonsillectomy (p=0.038) remained independent prognosticators of recurrence.
Conclusions: In this series, previous tonsillectomy was an independent predictor of recurrence after RC for BC. These data suggest that immunological alterations which may occur after tonsillectomy may exert an adverse long-term effect on survival of patients with invasive BC.
