The results of this large, contemporary, multi-institutional series show that radical cystectomy and pelvic lymphadenectomy provide durable local control and disease specific survival in patients with localized invasive transitional cell carcinoma.

No abstract

We present a detailed map of regional LN involvement in patients treated with radical cystectomy and lymph node dissection for transitional cell cancer of the bladder. Extensive LN dissection is essential for the complete removal of disease and accurate staging.

Aims: To develop multivariate nomograms that determine the probabilities of all-cause and bladder cancer^specific survival after radical cystectomy and to compare their predictive accuracy to that of American Joint Committee on Cancer (AJCC) staging. Methods: We used Cox proportional hazards regression analyses to model variables of 731 consecutive patients treated with radical cystectomy and bilateral pelvic lymphadenectomy for bladder transitional cell carcinoma. Variables included age of patient, gender, pathologic stage (pT), pathologic grade, carcinoma in situ, lymphovascular invasion (LVI), lymph node status (pN), neoadjuvant chemotherapy (NACH), adjuvant chemotherapy (ACH), and adjuvant external beam radiotherapy (AXRT). Two hundred bootstrap resamples were used to reduce overfit bias and for internal validation. Results: During a mean follow-up of 36.4 months, 290 of 731 (39.7%) patients died; 196 of 290 patients (67.6%) died of bladder cancer. Actuarial all-cause survival estimates were 56.3% [95% confidence interval (95% CI), 51.8-60.6%] and 42.9% (95% CI, 37.3-48.4%) at 5 and 8 years after cystectomy, respectively. Actuarial cancer-specific survival estimates were 67.3% (62.9-71.3%) and 58.7% (52.7-64.2%) at 5 and 8 years, respectively. The accuracy of a nomogram for prediction of all-cause survival (0.732) that included patient age, pT, pN, LVI, NACH, ACH, and AXRT was significantly superior (P = 0.001) to that of AJCC staging^based risk grouping (0.615). Similarly, the accuracy of a nomogram for prediction of cancer-specific survival that included pT, pN, LVI, NACH, and AXRT (0.791) was significantly superior (P = 0.001) to that of AJCC staging^based risk grouping (0.663). Conclusions: Multivariate nomograms provide a more accurate and relevant individualized prediction of survival after cystectomy compared with conventional prediction models, thereby allowing for improved patient counseling and treatment selection.Transitional cell carcinoma of the urinary bladder is a significant cause of morbidity and mortality worldwide. In the United States, bladder transitional cell carcinoma is the fifth most commonly diagnosed new cancer with an incidence of 63,210 new cases and 13,180 cancer-related deaths yearly (1). Radical cystectomy with bilateral pelvic lymphadenectomy is the most commonly applied primary treatment modality for individuals with muscle-invasive bladder cancer or refractory, high-grade nonmuscle invasive cancer. However, the 5-year allcause survival rate in patients with pathologically staged T 2 (pT 2 ; i.e., invasion into the bladder muscle) tumors is only 60% to 75% (2 -6).5 Tumors that exhibit extravesicle extension (i.e., pT 3 ) are associated with 36% to 58% 5-year survival, and pT 4 (i.e., invasion into contiguous structures) or node-positive tumors show 4% to 35% 5-year survival. Failure to cure is often due to the presence of occult metastases at the time of primary local therapy.Progression to measurable metastatic disease occurs, on average, 1 to 2 years after radical...

We have developed an international bladder cancer nomogram predicting recurrence risk after radical cystectomy for bladder cancer. The nomogram outperformed prognostic models that use standard pathologic subgroupings and should improve our ability to provide accurate risk assessments to patients after the surgical management of bladder cancer.