Predicting the survival of bladder carcinoma patients treated with radical cystectomy

Abstract

BACKGROUND Clinical outcomes vary for patients treated with radical cystectomy. The authors sought to identify factors associated with the survival of patients treated with radical cystectomy for urothelial carcinoma of the urinary bladder. METHODS The authors studied 218 patients treated with radical cystectomy for urothelial carcinoma between 1980 to 1984. Patient ages ranged from 41 to 78 years (mean, 64 years). Using the 1997 TNM system, T classifications were Ta (17 patients), T1 (44), T2 (71), T3a (42), T3b (14), T4a (28), and T4b (2). Thirty‐two patients had lymph node metastasis at the time of surgery. Histologic grade was determined according to the newly proposed World Health Organization and International Society of Urological Pathology grading system; tumor was low grade in 43 patients and high grade in 175. The male‐to‐female ratio was 4.9 to 1. The mean follow‐up of patients still alive was 13.1 years (median, 13.8 years; range, 30 days to 18 years). Cox proportional hazards models were used to determine the impact of numerous clinical and pathologic findings on survival. RESULTS Ten‐year local recurrence free, distant metastasis free, cancer specific, and all‐cause survival were 71%, 73%, 67%, and 41%, respectively. In univariate analysis, cancer size, T classification, and lymph node status were associated with distant metastasis free, cancer specific, and all‐cause survival. Histologic grade and surgical margin status were significantly associated with worse cancer specific and all‐cause survival, but not with distant metastasis free survival. In multivariate analysis, cancer size, margin status, T classification, and lymph node status were identified as significantly associated with cancer specific survival after adjustment for age and gender. CONCLUSIONS Long term survival is achieved in a significant number of patients treated with radical cystectomy. In this study, patients with organ‐confined (≤ pT2) and small size (≤ 3 cm) cancer had favorable 10‐year distant metastasis free (93%) and cancer specific survival (88%) after cystectomy. Tumor size, margin status, extravesical involvement, and lymph node metastasis are important pathologic factors and should be considered as stratification variables in identifying patients for whom adjuvant chemotherapy should be evaluated in clinical trials. Cancer 2000;88:2326–32. © 2000 American Cancer Society.

Staging and reporting of urothelial carcinoma of the urinary bladder

“…131 In recent cystectomy series, tumor size was an independent predictor of distant metastasis-free survival, cancer-specific survival, and overall survival (Figure 22). 3,85 The use of a 3 cm largest tumor diameter cutoff appeared to stratify patients into distinct prognostic groups. 3,85 Tumor Multifocality Development of multifocal tumors in the same patient, either synchronous or metachronous, is a common characteristic of urothelial malignancy.…”

“…3,85 The use of a 3 cm largest tumor diameter cutoff appeared to stratify patients into distinct prognostic groups. 3,85 Tumor Multifocality Development of multifocal tumors in the same patient, either synchronous or metachronous, is a common characteristic of urothelial malignancy. [132][133][134][135] Premalignant changes, such as dysplasia or CIS, often are found in urothelial mucosa aside from an invasive bladder cancer.…”

“…In a recent study of cystectomy specimens, which included more advanced cancers, tumor multifocality did not have prognostic significance. 3 …”

“…1 Pathological stage is the most important determinant of prognosis and treatment for bladder cancer. [2][3][4][5][6] An ideal staging system should accurately reflect the natural history of cancer at this site, describe the total cancer burden, assess the extent of spread at the time of diagnosis, and stratify patients into prognostic groups for treatment planning. Adoption of a uniform staging system permits comparison of therapeutic interventions among different institutions.…”

Pathologic evaluation of radical cystectomy specimens

“…Pathologic tumor stage, surgical margins, and lymph node status are the most important predictors of postcystectomy survival. 10 The number of lymph nodes retrieved also is an important determinant of outcome for patients with bladder carcinoma, regardless of whether they have positive or negative lymph node status. 11 Such pathologic features help to identify patients whose malignancies are likely to be cured by surgery and patients who have a high risk of developing tumor recurrences.…”