Depth of invasion to the bladder wall as a prognostic factor and its association with circulating cell-free DNA levels in patients with muscle-invasive bladder cancer

• Published in: Current urology 2023-12, Vol.17 (4), p.229-235
• Main Authors: Iemura, Yusuke, Miyake, Makito, Fukui, Shinji, Fujii, Tomomi, Ohnishi, Sayuri, Hori, Shunta, Morizawa, Yosuke, Nakai, Yasushi, Torimoto, Kazumasa, Tanaka, Nobumichi, Fujimoto, Kiyohide
• Format: Article
• Language: English
• Subjects: Original; Special Topic - Advances in Bladder Cancer Therapy
• ISSN: 1661-7649; 1661-7657
• DOI: 10.1097/CU9.0000000000000193

BackgroundRadical cystectomy (RC) is the standard surgical treatment for patients with muscle-invasive bladder cancer, but the prognosis is not favorable, and new prognostic factors need to be discovered. We investigated the potential of depth of invasion (DOI) as a prognostic factor in patients with muscle-invasive bladder cancer who underwent RC. Furthermore, we examined the association between preoperative levels of circulating cell-free DNA and DOI.Materials and methodsWe retrospectively reviewed patients who underwent RC between January 2007 and December 2017; those who received neoadjuvant chemotherapy were excluded. Depth of invasion was measured using hematoxylin-eosin-stained RC specimens.ResultsOf the 121 patients selected, 41 (33.9%) were eligible for analysis. The median follow-up period was 14 months and mean DOI was 17 mm (range, 2-75 mm). Long DOI (>17 mm) was significantly associated with shorter progression-free survival (hazard ratio, 14.5; 95% confidence interval, 3.9-53.97, p < 0.0001) and cancer-specific survival (hazard ratio, 18.97; 95% confidence interval, 4.04-88.99, p = 0.0002) compared with short DOI. Multivariate analysis revealed that DOI was an independent risk factor for cancer-specific survival. The levels of circulating cell-free DNA were significantly higher in patients with a longer DOI than in those with short DOI (65 vs. 20 ng/mL, respectively; p = 0.028).ConclusionsDepth of invasion predicted with levels of circulating cell-free DNA and thus could be a useful prognostic factor.