Muscle-Invasive Bladder Cancer: Predictive Factors and Prognostic Difference Between Primary and Progressive Tumors

• Published in: Urology (Ridgewood, N.J.) Vol. 70; no. 3; pp. 477 - 481
• Main Authors: Türkölmez, Kadir, Tokgöz, Hüsnü, Reşorlu, Berkan, Köse, Kenan, Bedük, Yaşar
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2007; Elsevier Science
• Subjects: BCG Vaccine - therapeutic use; Biological and medical sciences; Carcinoma, Transitional Cell - drug therapy; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Combined Modality Therapy; Cystectomy - statistics & numerical data; Disease Progression; Female; Humans; Kaplan-Meier Estimate; Lymph Node Excision; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Muscle, Smooth - pathology; Neoplasm Invasiveness; Neoplasm Metastasis; Nephrology. Urinary tract diseases; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Survival Analysis; Survival Rate; Tumors of the urinary system; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology; Nephrology; Urinary system disease; Prognosis; Malignant tumor; Urinary tract disease; Infiltrating tumor; Bladder cancer; Urology; Progressive; Primary; Bladder disease; Muscle; Predictive factor; Comparative study
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2007.05.008

Abstract Objectives To establish whether a difference in the clinical outcomes of patients with progressive and primary muscle-invasive bladder cancer exists. Methods The records of patients who had undergone radical cystectomy for bladder urothelial carcinoma from 1990 to 2005 were reviewed. According to our inclusion criteria, 109 patients with primary muscle-invasive tumor (group 1) and 45 patients with progressive tumors were selected (group 2). The correlation of clinical and pathologic variables with survival was investigated using the Cox proportional hazards test. The Kaplan-Meier method was used to estimate progression rates. Multivariate analysis was performed using the Cox regression survival method to investigate possible predictive factors. Results The 2, 3, and 5-year cancer-specific survival rate was 72%, 61%, and 43% for patients with progressive tumor and 75%, 62%, and 54% for patients with primary tumor, respectively ( P >0.05). For lymph node-negative tumors (pN0), the corresponding rates were 77%, 64%, and 56% in group 1 and 73%, 60%, and 39% in group 2 ( P >0.05). On multivariate analysis, lymphovascular invasion and pT stage of the primary tumor remained significant independent prognostic factors for cancer-specific survival. The detection of local and/or distant metastasis during follow-up significantly shortened the cancer-specific survival of patients with muscle-invasive bladder cancer. Conclusions The results of our study have shown that patients with progressive muscle-invasive urothelial tumors do not have a worse prognosis than do those with primary tumors. During the early postoperative years, even patients with progressive tumors had better disease-specific survival rates. For both groups, pT stage and lymphovascular invasion seemed to be independent predictors of decreased cancer-specific survival.