48 OVERALL SURVIVAL VERSUS DISEASE-SPECIFIC SURVIVAL VERSUS TUMOR-FREE SURVIVAL: WHICH IS THE BEST ENDPOINT FOR OUTCOME ANALYSIS IN A CYSTECTOMY SERIES FOR BLADDER CANCER?

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes1 Apr 201148 OVERALL SURVIVAL VERSUS DISEASE-SPECIFIC SURVIVAL VERSUS TUMOR-FREE SURVIVAL: WHICH IS THE BEST ENDPOINT FOR OUTCOME ANALYSIS IN A CYSTECTOMY SERIES FOR BLADDER CANCER? Christina Pfeiffer, Meike Seger, Richard Hautmann, and Bjoern Volkmer Christina PfeifferChristina Pfeiffer Kassel, Germany More articles by this author , Meike SegerMeike Seger Kassel, Germany More articles by this author , Richard HautmannRichard Hautmann Ulm, Germany More articles by this author , and Bjoern VolkmerBjoern Volkmer Kassel, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2650AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy and pelvic lymph node dissection is accepted as gold standard in the treatment of invasive transitional cell carcinoma (TCC) of the bladder. Comparing surgical therapy alone with combined neoadjuvant or adjuvant radio- and/or chemotherapy or with radio- and/or chemotherapy alone needs outcome analyses, that make different series comparable. METHODS We analyzed the data of a large homogenous single-center cystectomy series. We included all cases with TCC of the bladder with radical cystectomy and pelvic lymph node dissection, who had a R0 resection and no organ metastases or lymph node metastases outside the true pelvis. Complete data on the histopathologic tumor stage were obtained. All patients had a complete follow-up with 3-monthly visits until death or until 12/09. All incidents of tumor recurrence were registered. As endpoints we defined: death (overall survival), tumor-related death (disease-specific survival), first date of tumor recurrence (tumor-free survival). RESULTS We could include 1100 patients, who had surgery performed between 01/86 and 12/09. The median age was 65 (23–91) years. The median follow-up was 38 (0–282) months. At 1, 5, and 10 years the overall survival rate was 82.1%, 57.2%, and 44.7%, the disease-specific survival rate was 85.7%, 68.8%, and 64.9%, and the tumor-free survival rate was 81.1%, 68.7%; and 64.6%. In lymph node-negative tumors the 10year overall survival rate was 52.6%, while the disease-specific survival rate was 75.3%; in lymph node positive tumors these rates were 10.7% and 16.6%, respectively. The 10year-rate of not tumor-related death according to tumor stage was: pT1 pN0: 25.1%, pT2a pN0: 25.2%, pT2b pN0: 20.8%, pT3a pN0: 23.7%, pT3b pN0: 22.3%, pT4a pN0: 14.2%, pT4b pN0: 12%, pTall pN+: 5.9%. CONCLUSIONS There is only a very small difference between the long-term disease-specific and tumor-free survival rate reflecting the low early detection rate of tumor recurrence and the limited therapeutic results of all treatment modalities in these cases. The impact of tumor-related death on overall survival increases with tumor stage. The presence of lymph node metatases is associated with highest rates of tumor-related death. These patients may have the largest benefit from adjuvant therapies. Age and comorbidity strongly influence the overall survival, but not the disease-specific survival. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e20 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christina Pfeiffer Kassel, Germany More articles by this author Meike Seger Kassel, Germany More articles by this author Richard Hautmann Ulm, Germany More articles by this author Bjoern Volkmer Kassel, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...