Outcomes In Bladder Cancer Patients Research Articles

Identification of γ-synuclein as a stage-specific marker in bladder cancer by immunohistochemistry.

BackgroundPrevious studies have shown that the expression level of γ-synuclein (SNCG) is associated with progression of many different malignant tumors. In this study, we discuss and assess the prognostic ability of SNCG in bladder cancer.Material/MethodsMedical records (2005–2013) were retrospectively reviewed for the population of interest. SNCG expression was identified immunohistochemically from bladder cancer tissues of 113 bladder cancer patients. The survival rate was calculated by the Kaplan-Meier method. Cox proportional hazard regression model was used for analysis of predictors of bladder cancer.ResultsSNCG was overexpressed in bladder cancer tissues compared with the normal bladder tissues (p<0.0001). SNCG expression in bladder cancer tissue was strongly related to tumor stage. However, SNCG level was not a prognostic factor of survival.ConclusionsOur results demonstrate that SNCG is highly expressed in bladder cancer tissue and its expression is stage-specific, but it is not helpful for predicting outcome in bladder cancer patients.

Presentation, Treatment, and Outcomes for Bladder Cancer Patients With Nonurothelial Histologies Treated by Radical Cystectomy: Implications for Adjuvant Radiation Therapy

Presentation, Treatment, and Outcomes for Bladder Cancer Patients With Nonurothelial Histologies Treated by Radical Cystectomy: Implications for Adjuvant Radiation Therapy

The SPARC Score: A Multifactorial Outcome Prediction Model for Patients Undergoing Radical Cystectomy for Bladder Cancer

While multiple independent clinicopathological variables are associated with the outcome of radical cystectomy for bladder cancer, limited prediction tools exist to facilitate individualized risk assessment. We developed the SPARC (Survival Prediction After Radical Cystectomy) score, a prediction model for bladder cancer specific survival after radical cystectomy. We evaluated 2,403 patients who underwent radical cystectomy without neoadjuvant therapy at our institution between 1980 and 2008 with pathological re-review of all specimens. Of these patients 1,776 with nonmetastatic urothelial carcinoma were identified for analysis. A multivariate model was developed using stepwise selection to determine variables associated with cancer specific survival. We created a scoring system based on the β coefficients of this model. Median followup after radical cystectomy in patients alive at last followup was 10.5 years (IQR 7.3, 15.3), during which time 610 had died of bladder cancer. In addition to pathological tumor stage, nodal status, multifocality and lymphovascular invasion, the patient specific factors of Charlson comorbidity index, Eastern Cooperative Oncology Group (ECOG) performance status, current smoking, preoperative hydronephrosis and receipt of adjuvant chemotherapy were significantly associated with the risk of bladder cancer death. We used cumulative scores of these variables to stratify patients into risk groups with 95%, 80%, 60%, 38% and 23% 5-year cancer specific survival from the lowest to the highest risk group, respectively (p<0.0001). The concordance index of this model was 0.75. We present a model to individualize the estimation of cancer specific survival after radical cystectomy. Pending external validation, these data may be used for patient counseling, specifically in regard to recommendations for adjuvant therapy and surveillance frequency, as well as for clinical trial development.

Overexpression of Rab25 contributes to metastasis of bladder cancer through induction of epithelial–mesenchymal transition and activation of Akt/GSK-3β/Snail signaling

Rab25, an epithelial-specific member of the Rab family of small guanosine triphosphatases, is associated with several human cancers. The goal of this study was to determine its function in bladder cancer (BC). We examined the Rab25 expression pattern in two different cohorts of BC patients treated with radical cystectomy by quantitative PCR, western blotting and immunohistochemical staining. A series of in vitro and in vivo assays were performed to elucidate the function of Rab25 in BC and its underlying mechanisms. Rab25 expression was significantly elevated at both the messenger RNA and protein levels in BCs compared with normal bladder tissues. High Rab25 expression was closely associated with lymph node (LN) metastasis and was an independent predictor for poor disease-free survival in BC patients. Downregulation of Rab25 in BC cells markedly inhibited invasive motility in vitro and metastatic potential in vivo. In addition, downregulation of Rab25 in BC EJ and T24 cells increased the expression levels of epithelial markers (E-cadherin and α-catenin) and decreased the levels of mechamechy markers (vimentin and fibronectin). Simultaneously, downregulation of Rab25 in EJ and T24 cells resulted in the inactivation of downstream phosphorylated protein kinase B (p-Akt), phosphorylated glycogen synthase kinase-β (p-GSK-3β) and snail signaling. This study demonstrates that Rab25 can promote BC metastasis through induction of epithelial-mesenchymal transition process and activation of Akt/GSK-3β/Snail signaling pathway; Rab25 expression level can predict LN metastasis and inferior clinical outcome in BC patients.

Prognostic Value of Tissue Vascular Endothelial Growth Factor Expression in Bladder Cancer: a Meta-analysis

The prognostic role of vascular endothelial growth factor (VEGF) in bladder cancer remains controversial. This meta-analysis aimed to explore any association between overexpression and survival outcomes. We systematically searched for studies investigating the relationships between VEGF expression and outcome of bladder cancer patients. Study quality was assessed using the Newcastle-Ottawa Scale. After careful review, survival data were extracted from eligible studies. A meta-analysis was performed to generate combined hazard ratios (HRs) for overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS). A total of 1,285 patients from 11 studies were included in the analysis. Our results showed that tissue VEGF overexpression in patients with bladder cancer was associated with poor prognosis in terms of OS (HR, 1.843; 95% CI, 1.231-2.759; P = 0.003), DFS (HR, 1.498; 95% CI, 1.255-1.787; P = 0.000) and DSS (HR, 1.562; 95% CI, 0.996-1.00; P = 0.052), though the difference for DSS was not statistically significant. In addition, there was no evidence of publication bias as suggested by Begg's and Egger's tests except for DFS (Begg's test, P = 0.221; Egger's test, P = 0.018). The present meta-analysis indicated elevated VEGF expression to be associated with a poor prognosis in patients with bladder cancer.

The p63 Protein Isoform ΔNp63α Inhibits Epithelial-Mesenchymal Transition in Human Bladder Cancer Cells: ROLE OF MIR-205

Epithelial-mesenchymal transition (EMT) is a physiological process that plays important roles in tumor metastasis, "stemness," and drug resistance. EMT is typically characterized by the loss of the epithelial marker E-cadherin and increased expression of EMT-associated transcriptional repressors, including ZEB1 and ZEB2. The miR-200 family and miR-205 prevent EMT through suppression of ZEB1/2. p53 has been implicated in the regulation of miR-200c, but the mechanisms controlling miR-205 expression remain elusive. Here we report that the p53 family member and p63 isoform, ΔNp63α, promotes miR-205 transcription and controls EMT in human bladder cancer cells. ΔNp63α, E-cadherin and miR-205 were coexpressed in a panel of bladder cancer cell lines (n = 28) and a cohort of primary bladder tumors (n = 98). Stable knockdown of ΔNp63α in the "epithelial" bladder cancer cell line UM-UC6 decreased the expression of miR-205 and induced the expression of ZEB1/2, effects that were reversed by expression of exogenous miR-205. Conversely, overexpression of ΔNp63α in the "mesenchymal" bladder cancer cell line UM-UC3 induced miR-205 and suppressed ZEB1/2. ΔNp63α knockdown reduced the expression of the primary and mature forms of miR-205 and the miR-205 "host" gene (miR-205HG) and decreased binding of RNA Pol II to the miR-205HG promoter, inhibiting miR-205HG transcription. Finally, high miR-205 expression was associated with adverse clinical outcomes in bladder cancer patients. Together, our data demonstrate that ΔNp63α-mediated expression of miR-205 contributes to the regulation of EMT in bladder cancer cells and identify miR-205 as a molecular marker of the lethal subset of human bladder cancers.

Impact of Smoking and Smoking Cessation on Outcomes in Bladder Cancer Patients Treated with Radical Cystectomy

BackgroundCigarette smoking is the best-established risk factor for urothelial carcinoma development. ObjectiveTo elucidate the association of pretreatment smoking status, cumulative exposure, and time since smoking cessation on outcomes of patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC). Design, setting, and participantsWe retrospectively collected clinicopathologic and smoking variables, including smoking status, number of cigarettes per day (CPD), duration in years, and time since smoking cessation, for 1506 patients treated with RC for UCB. Lifetime cumulative smoking exposure was categorized as light short-term (≤20 CPD for ≤20 yr), light long-term (≤20 CPD for >20 yr), heavy short-term (>20 CPD for ≤20 yr), and heavy long-term (>20 CPD for >20 yr). InterventionRC and bilateral lymph node (LN) dissection without neoadjuvant chemotherapy. Outcome measurements and statistical analysisLogistic regression and competing risk analyses assessed the association of smoking with disease recurrence, cancer-specific mortality, and overall mortality. Results and limitationsThere was no difference in clinicopathologic factors between patients who had never smoked (20%), former smokers (46%), and current smokers (34%). Smoking status was associated with the cumulative incidence of disease recurrence (p=0.004) and cancer-specific mortality (p=0.016) in univariable analyses and with disease recurrence in multivariable analysis (p=0.02); current smokers had the highest cumulative incidences. Among ever smokers, cumulative smoking exposure was associated with advanced tumor stages (p<0.001), LN metastasis (p=0.002), disease recurrence (p<0.001), cancer-specific mortality (p=0.001), and overall mortality (p=0.037) in multivariable analyses that adjusted for standard characteristics; heavy long-term smokers had the worst outcomes, followed by light long-term, heavy short-term, and light short-term smokers. Smoking cessation ≥10 yr mitigated the risk of disease recurrence (hazard ratio [HR]: 0.44; p<0.001), cancer-specific mortality (HR: 0.42; p<0.001), and overall mortality (HR: 0.69; p=0.012) in multivariable analyses. The study is limited by its retrospective nature. ConclusionsSmoking is associated with worse prognosis after RC for UCB. This association seems to be dose-dependent, and its effects are mitigated by >10 yr smoking cessation. Health care practitioners should counsel smokers regarding the detrimental effects of smoking and the benefits of smoking cessation on UCB etiology and prognosis.

Perioperative management of nonmuscle-invasive bladder cancer

The management of nonmuscle-invasive bladder cancer is a challenge. Despite current guidelines, the treatment is suboptimal as illustrated by the high risk of recurrence and progression. Transurethral resection plays a pivotal role in the management of bladder cancer, but the quality varies dramatically. In this review, we discuss the latest developments that aim to improve the outcome of a transurethral resection such as photodynamic diagnosis, a second resection and adjuvant therapy. The treatment of a bladder cancer patient can be improved, for example, with a standard second resection in a subset of the patients or the use of visual enhancement techniques. There is conflicting data on the clinical value of techniques like photodynamic diagnosis, as it does not always seem to translate into a better long-term outcome. Comparison of studies is difficult because of differences in patient selection and endpoints. Better classification in (personalized) risk categories may facilitate the treatment choice and prediction of the long-term outcome. The outcome of bladder cancer patients can be improved. A good-quality transurethral resection of the bladder tumor is crucial and novel technological developments may improve the outcome, but they remain the subject of discussion.

High CD10 expression predicts favorable outcome in surgically treated lymph node–positive bladder cancer patients

CD10 predicts survival in different cancers. The prognostic significance in bladder cancer still has to be documented. One hundred fifty lymph node-positive bladder cancer patients were treated by cystectomy and standardized pelvic lymphadenectomy in curative intent. CD10 expression was evaluated in tissue microarrays (TMAs) constructed from histopathological normal urothelium, primary tumor (tumor center and invasion front), and corresponding lymph node metastases and correlated with tumor characteristics (stage, extracapsular extension, number, and total diameter of metastases) and survival. CD10 expression was successively lost from normal urothelium to primary tumor to metastases (P < .05) and decreased from the tumor center to the invasion front (P < .002). High CD10 expression in tumor center or invasion front (P < .05) but not in the metastases predicted favorable outcome; the prognostic information in the tumor center was independent from tumor stage and lymph node parameters. High CD10 expression level was not associated with specific tumor characteristics. A well-defined sampling strategy for TMAs allows detection of specific biomarker expression patterns and may generate prognostic information inherent in particular tumor areas. The favorable outcome in bladder cancer patients with high CD10 expression might suggest a tumor suppressive function of CD10.

Overexpression of Securin in Human Transitional Cell Carcinoma Specimens

Objective Securin, the product of PTTG (pituitary tumor transforming gene), is overexpressed in several tumors, and plays important roles in cancer progression and invasion. In our previous report, securin expression was observed in transitional cell carcinoma (TCC; the most common pathological pattern of bladder cancer) cell lines, including BFTC905, T24, and TSGH8301. However, the existence of securin in human bladder cancer specimens has not been established. Materials and Methods Commercial bladder cancer tissue arrays (BL208 & BLC661) were used. Slides of paraffin-fixed human bladder tissues included all grades of TCC (18, 22 and 29 tissue samples for grades I, II, and III, respectively), 21 superficial and 41 invasive TCC specimens, and 11 normal urothelial tissue samples. The intensities of securin immunostaining were graded as background, mild, and strong (scored as 0, 1, and 2, respectively), and scores from the nucleus and cytosol were analyzed separately. Results We have demonstrated, for the first time, the expression of securin in bladder tissues. Securin was overexpressed in the cytosol and nucleus of all TCC samples compared to normal urothelium, but only cytosolic localization revealed statistical significance. There were no differences in securin immunoreactivity among the different grades of TCC. Significant over-expression of cytosolic but not nuclear securin was found in both superficial and invasive TCC samples compared to normal urothelium. No difference in immunoreactive staining for nuclear and cytosolic securin between superficial and invasive TCC was noted. Conclusion Significant enhanced expression of cytosolic securin protein was found in human bladder cancer specimens, suggesting that the level of tissue securin may be a potential biomarker for the diagnosis of bladder cancer. Studies that investigate the relationship between securin expression and the outcomes of bladder cancer patients could be conducted in the future.

UP-1.80: Robotic-assisted laparoscopic radical cystectomy (RARC) with extracorporeal urinary diversion and robotic-assisted laparoscopic partial cystectomy (RAPC)

The goals of managing bladder cancers are to control cancer, as well as to improve the quality of life including reducing pain and skin incision and also urinary diversions are essential parts of bladder cancer patients. The aims of this study are to present the clinical outcomes of bladder cancer patients who underwent robotassisted laparoscopic radical cystectomy (RARC) with extracorporeal ileal conduit and robot-assisted laparoscopic partial cystectomy(RAPC).

Abstract 894: Genetic variations in the angiogenesis pathway modulate clinical outcomes of bladder cancer

Abstract Bladder cancer is the fourth most common cancer in men in the United States. There is compelling evidence suggesting that a patient's genetic background contributes to bladder cancer clinical outcome. Angiogenesis is an essential process required for tumor development, growth, and metastasis. We hypothesized that genetic variations in the angiogenesis pathway may affect the overall survival of bladder cancer patients. We conducted a follow-up study of 397 non-muscle invasive and 320 muscle-invasive bladder cancer patients to systematically evaluate 458 single nucleotide polymorphisms (SNPs) in 24 angiogenesis pathway genes as predicators of prognosis and BCG response. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by multivariate Cox proportional hazard regression adjusting for age, gender, stage, grade, and treatment regimen. In non-muscle invasive bladder cancer patients, no significant SNPs were identified after correction for multiple comparisons. When stratified by BCG treatment, variant KIT rs11735550 was significantly associated with recurrence in patients who did not receive BCG treatment (HR=2.84, 95%CI: 1.67-4.83). In muscle-invasive bladder cancer patients, variant FLT4 rs11750142, rs2447737, rs13168072, and rs11739750 genotypes, and wild-type rs11957360 were significantly associated with increased risk of dying. These SNPs are not in linkage disequilibrium suggesting that each one independently modulates survival. In addition, a significant gene dosage effect was observed for increased risk with increasing number of unfavorable genotypes (P for trend&amp;lt;0.001). Compared to the low-risk group (0-1 unfavorable genotypes), median-risk group (2-3 unfavorable genotypes) and high-risk group (4-5 unfavorable genotypes) showed 1.34- (95%CI: 0.86-2.11) and 2.60-fold (95%CI: 1.66-4.09) increased risk of dying, respectively. In Kaplan-Meier estimates, the low-, median-, and high-risk groups had significantly different median survival time (MST) of 81.9, 67.9, and 31.3 months, respectively (logrank P &amp;lt;0.01). These results support the hypothesis that genetic variations in the angiogenesis pathway modulate clinical outcomes for bladder cancer patients. These findings warrant further replication in independent populations, and could be useful in disease management and the development of targeted therapies for bladder cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 894.

Editorial Comment

Editorial Comment

Offline adaptive radiotherapy for bladder cancer using cone beam computed tomography

We investigated if an adaptive radiotherapy approach based on cone beam CT (CBCT) acquired during radical treatment was feasible and resulted in improved dosimetric outcomes for bladder cancer patients compared to conventional planning and treatment protocol. A secondary aim was to compare a conventional plan with a theoretical online process where positioning is based on soft tissue position on a daily basis and treatment plan choice is based on bladder size. A conventional treatment plan was derived from a planning CT scan in the radical radiotherapy of five patients with muscle invasive bladder cancer. In this offline adaptive protocol using CBCT, the patients had 10 CBCT: daily CBCT for the first five fractions and then CBCT scan on a weekly basis. The first five daily CBCT in each patient were used to create a single adaptive plan for treatment from fraction eight onwards. A different process using the planning CT and the first five daily CBCT was used to create small, average and large bladder volumes, giving rise to small, average and large adaptive bladder treatment plans, respectively. In a retrospective analysis using the CBCT scans, we compared the clinical target volume (CTV) coverage using three protocols: (i) conventional; (ii) offline adaptive; and (iii) online adaptive with choice of 'plan of the day'. Daily CBCT prolonged treatment time by an average of 7 min. Two of the five patients demonstrated such variation in CTV that an offline adaptive plan was used for treatment after the first five CBCT. Comparing the offline adaptive plan with the conventional plan, the CTV coverage improved from a minimum of 60.1 to 94.7% in subsequent weekly CBCT. Using the CBCT data, modelling an online adaptive protocol showed that coverage of the CTV by the 95% prescribed dose line by small, medium and large adaptive plans were 34.9, 67.4 and 90.7% of occasions, respectively. More normal tissue was irradiated using a conventional CTV to planning target volume margin (1.5 cm) compared to an online adaptive process (0.5 cm). An offline adaptive strategy improves dose coverage in certain patients to the CTV and results in a higher conformity index compared to conventional planning. Further research in online adaptive radiation therapy for bladder cancer is indicated.

IMPACT OF PREVIOUS RADIOTHERAPY FOR PROSTATE CANCER ON CLINICAL OUTCOMES OF BLADDER CANCER PATIENTS

Purpose The impact of prostate cancer radiotherapy on the biological behavior of bladder cancer remains unclear. We compared outcomes of bladder cancer patients previously treated for prostate cancer with radiotherapy versus other treatment modalities.

Identification of Bladder Cancer Patients at Risk for Recurrence or Progression: An Immunohistochemical Study Based on the Expression of Metallothionein

Despite similarities in tumor stage and grade the individual outcome of bladder cancer patients is not predictable. The ideal tool for treatment stratification has not yet been found. Metallothionein (MT) overexpression is correlated with poor tumor differentiation, resistance to chemotherapy, and impaired survival in different malignancies. The clinical relevance of MT expression for defining patients at high risk for recurrence or progression was assessed. MT was detected immunohistochemically and evaluated semiquantitively in tumor specimens of 103 male and 19 female patients (transsurethral resection: n = 94, cystectomy: n = 28). Mean age of the patients was 68 (38–87) yr. According to histopathological features, three groups were distinguished for further analysis (pTa-1G1–2, pTis/pT1G3, and muscle invasive tumors). A cutoff value of 50% immunoreactive cells was used for further analysis. The 5-yr tumor specific survival rate was significantly lower in patients with high MT expression (32 vs. 72%). Accordingly, impaired 5-yr recurrence (90 vs. 58%), and progression rates (78 vs. 54%) were associated with high MT expression. All patients suffering from pTis and pT1G3 tumors with MT expression above the cutoff value showed recurrence within less than 40 mo, whereas 26% of those patients with MT expression below the cutoff value remained long-term recurrence free. Long term progression free survival was detected in 75% of pT1G3 patients with MT expression below the cutoff value. In contrast, 68% of pT1G3 tumor patients with MT expression above the cutoff value progressed, all within the first 12 mo after initial tumor resection. A correlation between high MT expression and prognosis was demonstrated especially in pT1G3 and pTis tumors, where >50% MT expression was linked to shorter tumor-specific survival and increased recurrence/progression rates. Thus, MT expression seems to be a promising marker for further risk stratification in the clinical treatment of bladder cancer patients.

Measuring health‐related quality of life outcomes in bladder cancer patients using the Bladder Cancer Index (BCI)

Health-related quality of life (HRQOL) has not been adequately measured in bladder cancer. A recently developed reliable and disease-specific quality of life instrument (Bladder Cancer Index, BCI) was used to measure urinary, sexual, and bowel function and bother domains in patients with bladder cancer managed with several different interventions, including cystectomy and endoscopic-based procedures. Patients with bladder cancer were identified from a prospective bladder cancer outcomes database and contacted as part of an Institutional Review Board-approved study to assess treatment impact on HRQOL. HRQOL was measured using the BCI across stratified treatment groups. Bivariate and multivariable analyses adjusted for age, gender, income, education, relationship status, and follow-up time were performed to compare urinary, bowel, and sexual domains between treatment groups. In all, 315 bladder cancer patients treated at the University of Michigan completed the BCI in 2004. Significant differences were seen in mean BCI function and bother scores between cystectomy and native bladder treatment groups. In addition, urinary function scores were significantly lower among cystectomy patients treated with continent neobladder compared with those treated with ileal conduit (all pairwise P<.05). The BCI is responsive to functional and bother differences in patients with bladder cancer treated with different surgical approaches. Significant differences between therapy groups in each of the urinary, bowel, and sexual domains exist. Among patients treated with orthotopic continent urinary diversion, functional impairments related to urinary incontinence and lack of urinary control account for the low observed urinary function scores.

Human Papilloma Virus DNA and p53 Mutation Analysis on Bladder Washes in Relation to Clinical Outcome of Bladder Cancer

ObjectivesHigh-risk human papilloma virus (HPV) types stimulate degradation and deactivation of protein associated with the p53 tumour suppressor gene via the ubiquitin-dependent pathway. For a long time, changes of the p53 tumour suppressor gene have been correlated with poor clinical outcome in patients with superficial bladder cancer. We aimed to study the association between presence of (high-risk) HPV DNA, p53 status, and clinical outcome in bladder cancer patients. This study must be seen as a preliminary study to investigate this potentially important problem. Material and methodsFrom 107 patients, 166 bladder wash samples were obtained. p53 status was determined by mutation analysis, HPV detection, and genotyping by the SPF10-LiPA assay. Clinical data were abstracted from the medical files. ResultsThe prevalence of all-type and high-risk HPV infection in malignancies of the bladder was 15.2% and 8.1%, respectively. In high-grade tumours this prevalence was 18.2% and 10.6%, respectively. In grade 1, 2 and 3 tumours the infection rate of high-risk HPV types was 0%, 3.3%, and 10.6%, respectively (trend test: p=0.221). In Ta, T1, and T2–T4 tumours the high-risk HPV infection rate was 0%, 12.5% and 18.2%, respectively (trend test: p=0.045). In the p53 wild-type patients who showed progression, 1 of 9 patients had a high-risk type HPV infection. In the group of wild-type patients who showed no progression, 4 of 37 patients had a high-risk type HPV infection (odds ratio: 1.03; 95% confidence interval, 0.1–10.5). ConclusionsThe data of this pilot study show the suggestion of a positive trend in the correlation between tumour grade/stage and high-risk type HPV infection. However, no additional risk for progression is found for p53 wild-type patients with a high-risk HPV infection.

MP-12.17: Human papillomavirus DNA and p53 mutation analysis in relation to clinical outcome of bladder cancer

High risk HPV types stimulate degradation and deactivation of the p53 tumour suppressor gene via the ubiquitin-dependant pathway. Changes of the p53 tumour suppressor gene have been correlated with poor clinical outcome in patients with superficial bladder cancer. We aimed to study the association between presence of (high risk) HPV DNA, p53 status and clinical outcome in bladder cancer patients.

Improving outcomes with radical cystectomy for high-grade invasive bladder cancer

It is clear that the optimal clinical outcomes in bladder cancer patients requiring radical cystectomy are related to standard histopathologic variables of tumor grade, stage and lymph node status. However, other less well defined variables are also critical to the successful outcomes of these patients. Patients with muscle invasive bladder cancer and treating physicians should avoid unnecessary and significant treatment delays. In addition, hospital and surgeon-volume/experience are thought to be factors that may too be important components that relate to the clinical outcomes of patients following surgery. Lastly, there is a growing body of literature to support the concept of an appropriate lymphadenectomy at the time of surgery, for both node-positive and node-negative bladder cancer patients. It is becoming more obvious that there are multiple variables involved in the clinical success and outcomes of patients with bladder cancer following radical cystectomy. As treating physicians and surgeons we must be aware of these components to ensure the best outcomes for our patients.