Survival Rates after Radical Cystectomy according to Tumor Stage of Bladder Carcinoma at First Presentation

Abstract

Introduction: The aim of this study was to establish to what extent the survival rates of muscle-invasive bladder carcinoma are influenced by the tumor stage at initial presentation. Patients and Methods: This study examined the clinical course of 230 patients who underwent radical cystectomy for bladder carcinoma from 1992 to 2002. The patients were divided into three groups according to the histological results of the initial and final transurethral tumor resection (TURB). In group 1 (n = 41) radical cystectomy was carried out for a superficial bladder carcinoma which had a high likelihood of progressing. Group 2 (n = 57) consisted of patients who displayed a superficial tumor stage when they first presented and developed progressive muscle-invasive bladder carcinoma under conservative treatment. Group 3 (n = 132) was made up of patients who were already at the muscle-invasive tumor stage in the course of primary TURB. The histopathological characteristics of all transurethral tumor resections and radical cystectomy were recorded. Progression-free survival and overall survival in the three groups were then compared. Results: The average patient age when cystectomy was carried out was 63.9 (35–80) years and the average follow-up period was 38 months. An average of 2.3 (1–16) transurethral tumor resections were carried out before radical cystectomy (median = 1). Progression-free survival and overall survival of all 230 patients was 54 and 50%, respectively, after 5 years. The best result was a 74% progression-free 5-year survival rate with organ-confined lymph node-negative tumors (n = 106) which was statistically significant (p = 0.0004) compared to the progression-free 5-year survival rate of 50% for non-organ-confined, lymph node-negative tumors (n = 64). Lymph node-positive patients achieved a progression-free survival rate of 21% after 5 years regardless of the tumor infiltration. Patients in group 1 achieved a progression-free 5-year survival rate of 77% and an overall survival rate of 63% after 5 years. In group 2 patients achieved a progression-free survival rate of 51% after 5 years and an overall survival rate of 50%. In the case of primary muscle invasion (group 3), progression-free survival and overall survival were 49 and 46%, respectively, after 5 years. There was no significant difference between groups 2 and 3 with regard to their progression-free or overall survival rates (p > 0.35). However, both groups displayed a significantly poorer progression-free and overall survival rate compared with group 1 (p < 0.01). Conclusion: Our results show that superficial bladder carcinoma with tumor progress to muscle invasion does not have a better prognosis after radical cystectomy than initial muscle-invasive bladder carcinoma. Survival rates in this group can only be improved by singling out patients on the basis of risk factors at an earlier stage and carrying out a cystectomy.

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

“…No other factor biasing CSS was noted in the present series. The ratio of patients with secondary MIBC of all patients undergoing RC for MIBC in the present series was 25% and thus within the range of previous series (21.4 to 29.4%) [18,19,20,21,22]. No differences in e.g.…”

“…'s series was larger than the present one, it was assessed in retrospect from various institutions while the present series was assessed prospectively with homogeneous treatment pattern due to institutional guidelines of one centre. In analogy to the present analyses, those series found no differences in outcome between primary versus secondary MIBC [17,18]. A more recent retrospective series by de Vries et al [19] assessing 134 and 54 patients with primary and secondary MIBC, respectively, found comparable survival rates.…”

“…In 2002, Yiou et al [17] compared 43 and 12 patients with primary and secondary MIBC, respectively, reporting no difference in survival. May et al [18] compared 132 and 57 patients with primary and secondary MIBC, respectively, again finding no difference in outcome or any other clinicopathological parameter. While May at al.…”

Pathological staging of muscle invasive bladder cancer: is substaging of pT2 tumors really necessary?

“…For organ confined lymph node negative T2 tumors, May et al, reported a 74% progression free 5 year survival rate, which was very close to the ratios given for T1 tumors (18). In a study by Wishnow and colleagues, 5 year mean survival and disease free survival rates after radical cystectomy, were 82 and 77%, respectively for patients with Stage B disease (19).…”

The role of radiotherapy in urinary bladder cancer: current status

“…Considering this, RT would play a role in the treatment of tumors invading deeper layers and in eventually involved lymph nodes. The results presented in Weiss's study (12) seem to be superior when compared to TURB studies followed by intravesical BCG (40,41) and are relatively equivalent to radical cystectomy (42). This suggests that TURB followed by radiochemotherapy may be an adequate treatment for patients with high risk T1 stage.…”