Radical Cystectomy in the Treatment of Bladder Cancer: Oncological Outcome and Survival Predictors

Abstract

To better understand the result of radical cystectomy in the treatment of bladder cancer, we analyzed our data and reported the oncological outcomes and survival predictors. Patients underwent radical cystectomy for bladder transitional cell carcinoma between March 1995 and July 2007 were evaluated. The clinical course, pathological characteristics, and clinical outcomes were described and analyzed. A total of 148 patients (98 men and 50 women) with a median age of 66.7 years (range: 23.8-83.3) were included in the study. Median follow-up was 64 months. The perioperative mortality was 2.7%. The 5-year recurrence-free survival (RFS) and overall survival (OS) for all 148 patients was 61% and 53%, respectively. The 5-year RFS and OS were 68% and 62% for pT2, 65% and 59% for pT3, 11% and 9% for pT4, and 37% and 31% for nodal-positive disease, respectively. The number of positive lymph nodes was significantly associated with survival: 5-year RFS and OS were 54% and 33%, for patients with only 1-3 positive lymph nodes, whereas, all patients with >or= 4 positive lymph nodes had recurrence. On multivariate analysis, age > 60 years, pT4 tumors, and lymph node involvement had a negative impact on survival. Radical cystectomy can be curative in a significant portion of patients with organ-confined (T2 or less) and extravesical (pT3) bladder cancer. Age > 60 years, pT4 tumors, and nodal metastases were associated with poor prognosis. Patients with limited lymph node involvement (1-3 nodes) can be cured by surgery alone, whereas a more extensive lymph node metastasis (>or= 4 nodes) eventually results in recurrence. Concomitant prostate cancer is of low grade and early stage, and is clinically insignificant.