Outcome of radical cystectomy for bladder cancer according to the disease type at presentation

Abstract

Objective To examine whether the outcome of cystectomy for invasive transitional cell carcinoma (TCC) of the bladder was in¯uenced by the type of disease at initial presentation. Patients and methods The charts of 76 patients treated for TCC by radical cystectomy from 1987 to 1997 in our unit were reviewed. The patients were divided into three groups: group 1 comprised 43 patients with primary invasive disease; group 2 included 12 patients with progression of an initial super®cial bladder tumour after failure of conservative treatment; and group 3 comprised 21 patients who had a radical cystectomy for super®cial TCC, with a high risk of progression after attempts at conservative treatment. The pathological ®ndings on transurethral resection and cystectomy specimens, cancer-speci®c survival and the time to progression were compared among the three groups.Results The rate of pT0 in cystectomy specimens was 16%, 41% and 24% in groups 1, 2 and 3, respectively. Under-staging occurred in 24% of cases in group 3.The 10-year cancer-speci®c survival rates were 48%, 47% and 82% in groups 1, 2 and 3, respectively. The cancer-speci®c survival rate and progression rate were not signi®cantly different between groups 1 and 2, but were signi®cantly lower/higher in these patients than in group 3 (P<0.01). Conclusions These data suggest that the prognosis of super®cial TCC which progresses despite conservative management is no better than that of invasive TCC at initial presentation, despite the closer follow-up received by the former patients. Early identi®cation of this group of patients may improve the cancerspeci®c survival, as early cystectomy for high-risk super®cial TCC yields better results.

P0 Stage at Radical Cystectomy for Bladder Cancer is Associated with Improved Outcome Independent of Traditional Clinical Risk Factors

“…P0 rates across several series have ranged from 6% to 41% [1,[4][5][6][7] varying, in part, due to different types of neoadjuvant chemotherapy used, aggressiveness of the surgeon to perform a "complete re-TUR," patient characteristics, or meticulous assessment by the pathologist to detect focal microscopic focus of disease. Our P0 rate of 11%, though on the lower end of reported rates, is probably reflective of our referral pattern in that we are a tertiary cancer center.…”

Staging and reporting of urothelial carcinoma of the urinary bladder

“…The incidence of stage pT0 bladder carcinoma is approximately 10%. 5,[10][11][12][13][14] Unlike stage pT0 cancer of the prostate (so called 'vanishing cancer phenomenon'), the clinical outcome among patients with stage pT0 bladder cancer is variable. In the largest series of pT0 carcinomas (120 patients), the 5-year recurrence-free, cancer-specific, and overall survivals were 84, 88, and 84%, respectively.…”

Invasive T1 bladder cancer: indications and rationale for radical cystectomy

“…Clinical staging errors range from 24 to 62% for T1 bladder tumours [11][12][13][14][15][16]. Indeed, in a large group of patients with T1 bladder cancer who had RC, 34% were pathologically understaged (only half had organ-confined tumours) and 14% had metastatic disease to the regional lymph nodes at surgery [11].…”

“…The incidence of nodal involvement in patients treated with RC for invasive T1 bladder cancers is reportedly 12-15% [11,[16][17][18][19][20]. In one study, the number of TURs before RC for non-muscle-invasive TCC correlated with the prevalence of nodal involvement, with 8% of patients undergoing one TUR vs 24% undergoing four TURs [17].…”