Thoughts on Delaying Cystectomy

Abstract

030 elay can occur when a tumour is treated late in the course of the disease. While it is obvious that a pT2a tumour has a better prognosis than a pT3a, it is unclear whether a primary tumour of any stage has the same tumour-specific survival as a progressive tumour of the identical stage. Currently patients with primary and progressive muscle-invasive bladder cancer are treated equally, assuming a similar cancer-specific survival for both groups. However, the study of Schrier et al. [2] showed that patients with muscle-invasive disease and a history of superficial bladder cancer have a worse prognosis than patients with primary muscle-invasive bladder cancer. Their study shows a large and clinically significant difference in disease-specific survival between primary and progressive muscle-invasive cancer patients, favouring the primary group. The disease-specific survival appears to be approximately twice as high in the primary group at all times during follow-up. The 3and 5-yr survival rates are 67% and 55%, respectively, for patients with a primary invasive tumour, and 37% and 28%, respectively,