Impact of stage and comorbidities on five-year survival after radical cystectomy in Poland: single centre experience

Abstract

IntroductionLong-term outcomes of patients treated for invasive bladder cancer in Poland are poorly documented in the literature. Impact of various clinical parameters on their survival is even less well studied. Radical cystectomy is a major surgery, so the patients’ condition can be equally important as cancer stage. The aim of the study was to assess 5-year overall survival (OS) after cystectomy and impact of comorbidity on OS in a single Polish academic centre.Material and methodsClinical data of all patients who underwent cystectomy in years 2004-2006 for urothelial cancer were retrospectively reviewed. Survival status was determined at least 5 years after surgery. Pathological variables, comorbidities, surgery delay and complications were evaluated as potential predictors of OS. Kaplan-Meier estimates of the survival function as well as Cox proportional hazards models were utilized.ResultsThirty-day, 1-year and 5-year OS for 63 patients was 98.4%, 58.7% and 31.7%, respectively. None of the investigated parameters were significantly related to five-year OS. However, a composite parameter consisting of stage, diabetes status and postoperative course was found as a significant predictor. Five-year OS in 16 patients with pT1-2 and without diabetes and without post-operative complications was higher than in the remaining 47 patients (56% vs. 23%; P = 0.02).ConclusionsFive-year OS in our group was lower than in most published international series but concordant with a previous Polish report. Improvement in survival after radical cystectomy may be expected when early diagnosis will be accompanied by optimal care of patients with diabetes mellitus and avoidance of postoperative complications.

Is survival after radical cystectomy for bladder cancer in Saudi patients different from that of Western patients?

“…The pathological stage progression has a significant negative impact on survival in patients undergoing RC for bladder cancer as shown in many published series as well as in our study. 13 , 26 – 31 Metastases of bladder cancer to pelvic nodes varied between 14% and 27% and has been proven to be a highly, prejudicial variable that affect the DFS. In our series, 82 (25%) of the patients had metastatic lymph node involvement.…”

“…The 5-year DFS following RC and PLND was 54.3% in patients without lymph node metastases and 26.9% in patients with lymph node metastases; these results were comparable to other series. 8 , 11 , 26 , 27 , 31 – 34 …”

Stage of bladder cancer in Central Europe – Polish perspective

“…The data on European patients with bladder cancer come mainly from Western European countries. With latest papers presenting delay in radical cystectomy in over 20% of Central European patients and a 5-year survival following the surgery of 31.7% [3][4][5], one can think about differences in culture, lifestyle and health policy between the region of Central and Western Europe. As a consequence, we decided to perform The main finding of our study is that the stage of primary bladder cancer in Poland differs from literature data.…”

“…Due to these facts, MIBC requires special attention among clinicians. Recently Dybowski et al outlined relatively poor survival after radical cystectomy in Poland [3]. This leads to open discussion about factors that can be modified in order to improve treatment outcomes in Central Europe.…”

Extent of lymphadenectomy in patients with bladder cancer undergoing radical cystectomy - a multi-institutional analysis

“…While the majority of Polish patients with MIBC are qualified for radical cystectomy [7], the overall postoperative survival is relatively low and does not exceed 32% at five years [8]. Among many potential reasons, the quality of the surgery seems to be one of the most important factors.…”