Oncological Outcome of Primary versus Secondary Muscle-Invasive Bladder Cancer Is Comparable after Radical Cystectomy

Abstract

Background: High-risk non-muscle-invasive bladder cancer (NMIBC) progressing to muscle-invasive bladder cancer (MIBC) is associated with adverse tumour biology. It is unclear, however, whether outcome of NMIBC progressing to MIBC is adverse compared to primary MIBC and whether NMIBC of higher risk of progression to MIBC is adverse compared to NMIBC of lower risk. Objective: Our objective was to assess cancer-specific survival (CSS) following radical cystectomy (RC) for primary MIBC and for NMIBC progressing to MIBC in dependence of EORTC risk score. Materials and Methods: Clinical and histopathological characteristics and CSS of 150 patients were assessed. Secondary MIBCs were stratified by EORTC risk score at the last transurethral resection of bladder tumour for NMIBC. Results: CSS did not differ significantly between primary and secondary MIBC (p = 0.521). Secondary MIBC with high EORTC score had significantly shorter CSS compared to secondary MIBC with intermediate EORTC score (p = 0.029). In multivariable analysis, pathological tumour stage (HR = 3.77; p = 0.020) and lymph node stage (HR = 2.34; p = 0.022) were significantly correlated with CSS. Conclusion: While the outcome of secondary MIBC is not generally adverse compared to primary MIBC, the EORTC risk score not only reflects high risk of progression of NMIBC to MIBC, but also worse outcome following RC for secondary MIBC. Timely RC should thus be debated in high-risk NMIBC.

Survival after Radical Cystectomy for Bladder Cancer in Relation to Prior Non-Muscle Invasive Disease in Quebec

“…Aziz et al [4] showed that DSS did not differ significantly between both groups (p = 0.521) but when they classified progressive NMIBC according to EORTC risk score [3], they found that progressive NMIBC with a high score had a significantly shorter DSS compared to progressive NMIBC with intermediate EORTC score (p = 0.029). Similarly, de Vries et al [5] found no difference in survival between both groups with a 5-year DSS rate of 52% in the progressive group and 49% in the primary group.…”

“…However, the oncological outcome of de novo vs. progressive MIBC patients after RC remains inconsistent in the literature, with varying and sometimes even with contradictory results regarding survival. Several authors have reported either similar or insignificantly different and comparable survival rates between the 2 groups [4,5,6,7,8,9,10,11]. Others have reported better survival in patients who progressed after initial presentation as NMIBC [12,13,14,] while yet others have reported worse prognosis if RC is performed in patients who progress to MIBC after having NMBIC [15,16.…”

Relationship of the Number of Removed Lymph Nodes to Bladder Cancer and Competing Mortality After Radical Cystectomy

“…In a study in relatively young patients (median age: 53 yr) without adjuvant chemotherapy, extended lymph node dissection (median of 49 vs 16 nodes removed) was associated with higher disease-free survival than standard lymphadenectomy, with a greater effect in node-positive patients [4]. Other authors found no relationship between the lymph node count and diseasespecific survival [5]. Extended and superextended lymph node dissection (median of 22 vs 38 nodes removed, respectively) was associated with virtually identical recurrence-free and overall survival rates [6].…”

Oncological Outcome of Primary and Secondary Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-analysis

“…Secondary MIBC compared to primary MIBC could convey superior outcome because of the initial non-muscle invasive bladder cancer character or likewise convey inferior outcome because of its progressive tumor biology 7 , 8 , 13 , 22 . Meanwhile, similar prognosis was also reported in some studies 10 , 11 .…”