Positive surgical margin after attempted radical surgery in patients with locally advanced urothelial carcinoma: literature review and case reports
https://doi.org/10.18027/2224-5057-2024-002
Abstract
Positive surgical margin is observed in approximately 10 % of specimens after radical surgery for locally advanced urothelial carcinoma, and is associated with an increased risk of locoregional recurrence, metastases, and death. R+ patients are a heterogeneous group of patients requiring individual treatment approaches. There is no standard of care for R+ patients; acceptable options include observation, removal of residual tumor, postoperative chemotherapy (CT), immunotherapy (IT), radiation therapy (RT), and chemoradiotherapy (CRT). The choice of treatment plan depends on the location and characteristics of the primary tumor, use of neoadjuvant chemotherapy (NACT) before surgery and the response to it, the pathological response, the presence of detectable residual tumor, as well as the potential tolerability of immediate postoperative treatment.
Supporting agencies: The article was prepared without sponsorship
About the Authors
М. I. Volkova
Oncology Center No. 1 of the City Clinical Hospital named after S. S. Yudin of the Moscow Department of Health; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
Russian Federation
117152; 18A Zagorodnoe Shosse; 125993; Build. 1, 2 / 1 Barrikadnaya St.; Moscow
Ya. V. Gridneva
Oncology Center No. 1 of the City Clinical Hospital named after S. S. Yudin of the Moscow Department of Health; I. M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Russian Federation
Russian Federation
117152; 18A Zagorodnoe Shosse; 119991; Build. 2, 8 Trubetskaya St.; Moscow
I. S. Al-Akel
Oncology Center No. 1 of the City Clinical Hospital named after S. S. Yudin of the Moscow Department of Health
Russian Federation
Russian Federation
117152; 18A Zagorodnoe Shosse; Moscow
R. I. Ryabinin
Oncology Center No. 1 of the City Clinical Hospital named after S. S. Yudin of the Moscow Department of Health
Russian Federation
Russian Federation
117152; 18A Zagorodnoe Shosse; Moscow
References
1. Gladkov O.A., Bulychkin P.V., Volkova M.I. et. al. Practical recommendations for drug treatment of bladder cancer. Zlokachestvennie opuholi = Malignant Tumors 2023;13(3s2):620–639. doi: 10.18027/2224-5057-2023-13-3s2-1-620-639. (In Russ.)
2. Clinical Guidelines. Bladder Cancer, 2023. Available at: https://cr.minzdrav.gov.ru/schema/11_3. (In Russ.)
3. Bajorin D.F., Witjes J.A., Gschwend J.E. et.al. Adjuvant nivolumab versus placebo in muscle-invasive urothelial carcinoma. N Engl J Med 2021;384(22):2102–2114. doi: 10.1056/NEJMoa2034442.
4. Leaflet - information for the patient Opdivo, 10 mg/kg. Available at: https://grls.rosminzdrav.ru/InstrImg/2023/05/16/1493561/173eab27-c014-41e6-bd7b-a165ca84aac3.pdf
5. Clinical Guidelines. Urothelial cancer of the upper urinary tract, 2023. Available at: https://oncology-association.ru/wp-content/uploads/2023/11/urotelialnyj_rak_verhnih_moch_putej_23.pdf?ysclid=lywpj4ujz8771414912. (In Russ.)
6. Hong Xuwei, Li Tieqiu, Ling F., et al. Impact of surgical margin status on the outcome of bladder cancer treated by radical cystectomy: a meta-analysis. Oncotarget 2017;8(10):17258–17269. doi: 10.18632/oncotarget.12907
7. Dotan Z.A., Kavanagh K., Yossepowitch O., et al. Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. J Urol 2007;178(6):2308–12. doi: 10.1016/j.juro.2007.08.023
8. Marcq G., Afferi L., Neuzillet Y., et al. Oncological outcomes for patients harboring positive surgical margins following radical cystectomy for muscle-invasive bladder cancer: A retrospective multicentric study on behalf of the yau urothelial group. Cancers (Basel) 2022;14(23):5740. doi: 10.3390/cancers14235740
9. Colin P., Ouzzane A., Yates D.R., et al. Influence of positive surgical margin status after radical nephroureterectomy on upper urinary tract urothelial carcinoma survival. Ann Surg Oncol 2012;19(11):3613–3620. doi: 10.1245/s10434-012-2453-9
10. Advanced Bladder Cancer (ABC) Meta-analysis Collaborators Group. Adjuvant chemotherapy for muscle-invasive Bladder Cancer : A systematic review and meta-analysis of individual participant data from randomised controlled trials. Eur Urol 2022;81(1):50–61. doi: 10.1016/j.eururo.2021.09.028
11. El-Monim H.A., El-Baradie M.M., Younis A., Ragab Y, Labib A, El-Attar I. A prospective randomized trial for рost-operative vs. preoperative adjuvant radiotherapy for muscle-invasive bladder cancer. Urol Oncol 2013;31(3):359–65. doi: 10.1016/j.urolonc.2011.01.008
12. Zaghloul M.S., Awwad H.K., Akoush H.H. et.al. Postoperative radiotherapy of carcinoma in bilharzial bladder: improved disease free survival through improving local control. Int J Radiat Oncol Biol Phys 1992;23(3):511–7. doi: 10.1016/0360-3016(92)90005-3
13. Zaghloul M.S., Christodouleas J.P., Smith A., et al. Adjuvant sandwich chemotherapy plus radiotherapy vs adjuvant chemotherapy alone for locally advanced bladder cancer after radical cystectomy: a randomized phase 2 trial. JAMA Surg 2018;153(1):e174591. doi: 10.1001/jamasurg.2017.4591
14. Shariat S.F., Karakiewicz P.I., Palapattu G.S., et al. Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol 2006;176(6 pt 1):2414–22. doi: 10.1016/j.juro.2006.08.004
15. Zaghloul M.S., El Baradie M., Nouh, et al. Prognostic index for primary adenocarcinoma of the urinary bladder. Gulf J Oncol 2007;(2):47–54
16. Raheem A. MA., Hameed D. A, ElGanainy E. O, et al. Can Bcl-XL expression predict the radio sensitivity of Bilharzial related squamous bladder carcinoma? A prospective comparative study. BMC Cancer 2011;11:16. doi: 10.1186/1471-2407-11-16
17. Lewis G.D., Haque W., Verma V., et al. The role of adjuvant radiation therapy in locally advanced bladder cancer. Bladder Cancer 2018;4(2):205–213. doi: 10.3233/BLC-180163
18. Birtle A., Johnson M., Chester J., et al. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomized controlled trial. Lancet 2020;395(10232):1268–1277. doi: 10.1016/S0140-6736(20)30415-3
19. Chen B., Zeng Z.-C., Wang G.-M., et al. Radiotherapy may improve overall survival of patients with T3/T4 transitional cell carcinoma of the renal pelvis or ureter and delay bladder tumour relapse. BMC Cancer 2011;11:297. doi: 10.1186/1471-2407-11-297
20. Jwa E., Kim Y.S., Ahn H., et al. Adjuvant radiotherapy for stage III/IV urothelial carcinoma of the upper tract. Anticancer Res 2014;34(1):333–8. PMID: 24403484
21. Czito B., Zietman A., Kaufman D. et.al. Adjuvant radiotherapy with and without concurrent chemotherapy forlocally advanced transitional cell сarcinoma of the renal pelvis andureter. J Urol 2004;172(4 Pt 1):1271–5. doi: 10.1097/01.ju.0000137910.38441.8a
22. Vassilakopoulou M., Rouge T.D., Colin P., et al. Outcomes after adjuvant chemotherapy in the treatment of high-risk urothelial carcinoma of the upper urinary tract (UUT-UC): results from a large multicenter collaborative study. Cancer 2011;117(24):5500–8. doi: 10.1002/cncr.26172
23. Yang X., Li P., Deng X., et al. Perioperative treatments for resected upper tract urothelial carcinoma: a network meta-analysis. Oncotarget 2017;8(2):3568–3580. doi: 10.18632/oncotarget.12239.
Review
For citations:
Volkova М.I., Gridneva Ya.V., Al-Akel I.S., Ryabinin R.I. Positive surgical margin after attempted radical surgery in patients with locally advanced urothelial carcinoma: literature review and case reports. Malignant tumours. 2024;14(2):58-64. (In Russ.) https://doi.org/10.18027/2224-5057-2024-002
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