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Radical Cystectomy Provides Good Survival Results in Patients With Locally Advanced Bladder Cancer

Radical cystectomy with lymph node dissection for invasive bladder cancer appears to result in a 68% 5-year survival rate, according to the findings of a new retrospective study.

According to the researchers, radical cystectomy with lymph node dissection has emerged as a standard therapy for patients with invasive bladder cancer. Previous results using older surgery techniques resulted in a cure for only about 40% of patients treated for high-grade invasive disease, and most patients subsequently died of metastatic disease within 3 years. However, the morbidity and mortality associated with contemporary surgery may have improved survival.

To evaluate this issue, Hiroyuki Nishiyama, MD, with Kyoto University, Sakyo-ku, Japan and colleagues conducted a multi-institutional analysis to establish the contemporary clinical outcome of invasive bladder cancer treated with radical cystectomy in Japan.

Data were analysed retrospectively for 1,131 consecutive patients who underwent radical cystectomy for invasive bladder cancer between January 1990 and December 2000 at 32 hospitals.

Histopathological analysis demonstrated that 92.1% of patients harboured transitional cell carcinomas (TCCs) whereas 7.9% of patients presented with non-TCCs, including squamous cell carcinoma and adenocarcinoma. A total of 1,013 patients underwent pelvic lymphadenectomy. Among those, pathologically confirmed lymph node metastases were found in 16.0% of patients.

The overall 5-year survival was 68.0%, the researchers report. Approximately 79% of the deaths occurred within 3 years. In addition, multivariate analysis suggested that gender, clinical stage, pathological stage, lymph node involvement, and lymph node dissection were independently predictive of survival. In contrast, histological type, sex and grade had no significant impact on survival, the authors note.

"The outcome reported from this large group of patients demonstrates that radical cystectomy provides good survival results, with excellent local tumour control, Dr. Nishiyama and colleagues conclude.

According to the researchers, results from "this large series of patients provide sound data and a standard with which other forms of therapy for invasive bladder cancer can be compared."




Eur Urol 2004;45:176-181. "Clinical Outcome of a Large-Scale Multi-Institutional Retrospective Study for Locally Advanced Bladder Cancer: A Survey Including 1131 Patients Treated during 1990-2000 in Japan"

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