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Early vs delayed radical cystectomy for ‘high‐risk’ carcinoma not invading bladder muscle: delay of cystectomy reduces cancer‐specific survival
Author(s) -
Jäger Wolfgang,
Thomas Christian,
Haag Silke,
Hampel Christian,
Salzer Alice,
Thüroff Joachim W.,
Wiesner Christoph
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09980.x
Subject(s) - cystectomy , medicine , bladder cancer , urology , hazard ratio , confidence interval , oncology , cancer , surgery
Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The decision to attempt bladder preservation or to perform radical cystectomy in patients with ‘high‐risk’ carcinoma not invading bladder muscle (nmiBCA) is challenging and one of the most difficult management issues in urological oncology. Treatment strategies refer to the pathological T‐stage diagnosed at TURB and to risk assessment regarding tumour recurrence and progression. We analysed the impact of a delayed radical cystectomy (rCx) and clinical variables on cancer specific survival (CSS) in patients presenting ‘high‐risk’ nmiBCA. Our results show that delaying rCx after first diagnosis and multiple TURBs reduce CSS and should therefore be avoided. OBJECTIVE • To analyze the impact of a delayed radical cystectomy (rCx) and clinical variables on cancer‐specific survival (CSS) in patients presenting ‘high‐risk’ carcinoma not invading bladder muscle (nmiBCA). PATIENTS AND METHODS • Between 1989 and 2006, 278 patients who presented ‘high‐risk’ nmiBCA finally underwent rCx in our institution. • CSS was correlated with clinical variables such as the number of transurethral resections of the bladder (TURBs), interval between first TURB and rCx, adjuvant therapies, tumour upstaging at rCx, tumour stage and lymph node (LN) status. RESULTS • The overall 5‐ and 10‐year CSS was 82% and 76%, respectively. Significant correlations were found between the 5‐year CSS and categorized number of TURBs (≤2 vs >2: 88% vs 71%; P = 0.001), interval between first TURB and rCx (≤4 months vs >4 months: 86% vs 77%; P = 0.04), adjuvant therapies (no vs yes: 86% vs 66%; P = 0.001), tumour upstaging at rCx (no vs yes: 89% vs 67%; P < 0.001), tumour stage at rCx (bladder confined vs non‐confined: 88% vs 56%; P < 0.001) and LN status (no vs yes: 88% vs 36%; P < 0.001). • Multivariate analysis identified categorized number of TURBs (hazard ratio, HR, 0.14; 95% CI, 0.07–0.44; P < 0.001), categorized interval between first TURB and rCx (HR, 3.27; 95% CI, 1.24–8.59; P = 0.017), LN status (HR, 0.13; 95% CI, 0.06–0.26; P < 0.001) and tumour stage at rCx (HR, 0.49; 95% CI, 0.26–0.92; P = 0.03) as independent risk factors for CSS. CONCLUSION • Delay of rCx in ‘high‐risk’ nmiBCA deteriorates CSS and should be avoided. The number of TURBs and the interval between first TURB and rCx are causative factors for delayed rCx and are independently correlated with CSS.