Cystectomy for bladder cancer: a contemporary series.
OBJECTIVE
To validate the current TNM staging system, we analyzed our contemporary experience with 300 cystectomies.


METHODS
The pathological material and medical records of 300 patients treated with cystectomy were reviewed, and the new TNM classification was adopted.


RESULTS
The median followup of patients with no evidence of disease was 65 months, and overall survival rate was 45% with a median survival of 50 months. In a Cox regression analysis only patient age, pT stage and neoadjuvant chemotherapy were significant factors for survival. The disease specific survival was 67% with a median survival of 94 months. In a multiple proportional hazards analysis only pT stage and previous chemotherapy were significant factors of disease specific survival. A significant difference was seen in the overall and disease specific survival between patients with organ confined and nonorgan confined tumors. We did not observe a difference in the survival rate among patients with pT4a to pT3 tumors. Significant differences were not seen in survival rates between sexes or among patients of different age groups. Transitional cell carcinoma was the predominant histological type, and no significant difference was found in patient outcome among the different histological subtypes.


CONCLUSIONS
Bladder cancer can be categorized into organ confined and nonorgan confined tumors. This dichotomous grouping is better suited for evaluating adjuvant clinical trials. The pT stage of the bladder and prostate should be prospectively analyzed together to better define the clinical implications of prostatic involvement. In our opinion the histological subtypes do not affect outcome.
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Dalbagni
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Genega
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Hashibe
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Zhang
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Russo
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Herr
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Reuter
D000328:Adult; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery