Outcomes of pT0N0 at radical cystectomy: The Canadian Bladder Cancer Network experience

Abstract

Introduction: Radical cystectomy is the standard treatment for muscle invasive bladder cancer. We assessed clinical outcomes in patients found to have no evidence of disease (i.e., pT0N0) following radical cystectomy. Methods: We collected and pooled a database of 2287 patients who underwent radical cystectomy between 1993 and 2008 in eight centres across Canada. Of this number, 135 patients were found to have pT0N0 bladder cancer at the time of cystectomy. Survival data and prognostic variables were analyzed using KaplanMeier method and Cox proportional hazard regression analysis. Results: Median patient age was 66 years with a mean follow-up of 42 months. Clinical stage distribution was Tis 8.9%, Ta 1.5%, T1 20.7%, T2 45.2%, T3 5.2%, and T4 5.2%. The five-year recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were 83%, 96%, and 88%, respectively. The 10-year RFS, DSS and OS were 66%, 92%, and 70%, respectively. On Cox proportional regression analysis, no variables were associated with disease recurrence and only patient age was associated with overall survival. Interpretation: Patients with pT0N0 pathology after cystectomy have excellent outcomes with high five-and 10-year RFS, DSS and OS. However, there is still a risk of tumour recurrence in this patient population and thus postoperative surveillance is still required.

Review on gender differences in non-muscle invasive bladder cancer

“…In a group of patients with CIS resistant to TURBT complemented with intravesical BCG therapy treated with RC, female sex was an independent risk factor for increased CSM (P=0.029) ( 50 ). Similar conclusions have been revealed in cohorts treated with RC, which had no evidence of disease (pT0N0) following RC ( 51 ). On the other hand the data published by Soave et al and Mitra et al showed no difference in survival among gender treated with RC for NMIBC ( 52 , 53 ).…”