Delaying Radical Cystectomy for Muscle Invasive Bladder Cancer Results in Worse Pathological Stage

Abstract

While radical cystectomy remains the treatment of choice for invasive transitional cell carcinoma, the importance of its timing has been increasingly scrutinized. We determined whether the interval between diagnosis of muscle invasion and definitive radical cystectomy influenced pathological staging outcome. Of the 303 patients who underwent radical cystectomy from January 1998 to December 2001, 153 were diagnosed with muscle invasive transitional cell carcinoma at transurethral resection. Charts were reviewed for pathological stage, demographics and time between diagnosis of muscle invasion and radical cystectomy. Mean patient age was 67.2 years (range 35 to 88) with the majority (121 of 153, 79%) being male. At the time of cystectomy, 68 of 153 (44%) patients had organ confined disease (pT2B or lower), while node positive disease was found in 58 of 153 patients (38%). Mean time from transurethral resection diagnosis of muscle invasive disease until cystectomy was 63 days (range 8 to 473). A statistically significant correlation existed between time of diagnosis and cystectomy, and final pathological stage. Specifically, those patients with an interval greater than 90 days were more likely to have pT3 or higher, nonorgan confined disease compared to those patients undergoing cystectomy before 90 days (81% versus 52%, p = 0.01). Furthermore, those patients with organ confined disease had a significantly shorter mean time between diagnosis and cystectomy of 47.5 days versus 75.1 days for nonorgan confined disease (t test p = 0.02). In patients with muscle invasion at diagnosis, a delay in surgery is associated with more advanced pathological stage, especially when the delay is longer than 90 days. While appropriate time should be given for consideration of options and pretreatment evaluation, undue delay may compromise cancer control.