Elevated preoperative plasma level of
endoglin has been associated with worse oncologic outcomes in various
malignancies. The present large-scale study aimed to determine the predictive and prognostic values of preoperative
endoglin with regard to clinicopathologic and survival outcomes in patients treated with
radical cystectomy (RC) for nonmetastatic urothelial
carcinoma of the bladder (UCB). We prospectively collected preoperative blood samples from 1036 consecutive patients treated with RC for UCB. Logistic and Cox regression analyses were undertaken to assess the correlation of
endoglin levels with pathologic and survival outcomes, respectively. The AUC and C-index were used to assess the discrimination. Patients with adverse pathologic features had significantly higher median preoperative
endoglin plasma levels than their counterparts. Higher preoperative
endoglin level was independently associated with an increased risk for
lymph node metastasis, ≥pT3 disease, and nonorgan confined disease (NOCD; all p < 0.001). Plasma
endoglin level was also independently associated with
cancer-specific and overall survival in both pre- and postoperative models (all p < 0.05), as well as with recurrence-free survival (RFS) in the preoperative model (p < 0.001). The addition of
endoglin to the preoperative standard model improved its discrimination for prediction of
lymph node metastasis, ≥pT3 disease, NOCD, and RFS (differential increases in C-indices: 10%, 5%, 5.8%, and 4%, respectively). Preoperative plasma
endoglin is associated with features of biologically and clinically aggressive UCB as well as survival outcomes. Therefore, it seems to hold the potential of identifying UCB patients who may benefit from intensified
therapy in addition to RC such as extended
lymphadenectomy or/and preoperative systemic
therapy.