Abstract
cancer-specific survival (CSS) rate was 96% for the CR patients vs 51% for non-CR (p .0001, median followup 47 m). Pathological findings of 122 cystectomy specimens were: pT0/Ta,is,1/T2/T3/T4a 59/ 26/10/24/3; median (range) no. lymph nodes removed, 9 (0–27); pN0/ N /Nx 102/8/12; lymphovascular invasion, no/yes 91/31. Among these variables, pT3-4a (hazard ratio [HR] 8.3 vs pT0-2, p .0001) and pN (HR 3.0 vs pN0, p .037) were identified as significant and independent risk factors for cancer death. Based on these risk factors, CSS of non-CR patients was clearly stratified into high-risk (pT3-4a and/or pN , 5-yr CSS rate 20%) and low-risk (pT0-2pN0, 5-yr CSS rate 85%). CONCLUSIONS: In bladder-sparing protocols, non-CR patients after induction CRT, generally having poor prognosis despite cystectomy, are clearly stratified into favorable vs high risk group based on pathology of cystectomy specimens. Patients at high-risk (pT3-4a and/or pN ) are potential subjects for intensive adjuvant therapy including clinical trials.
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