title: Does early cystectomy improve the survival of patients with high risk superficial bladder tumors?
abstract: OBJECTIVE
  We compared survival after early versus delayed cystectomy in patients with high risk superficial bladder tumors.
  
  
  METHODS
  Of 307 patients with high risk superficial bladder tumors who were treated initially with transurethral resection and bacillus Calmette-Guerin (BCG) therapy 90 (29%) underwent cystectomy for recurrent tumor during a followup of 15 to 20 years. Disease specific survival distribution of these 90 patients was determined relative to the indications for and time of cystectomy.
  
  
  RESULTS
  Of the 90 patients who underwent cystectomy 44 (49%) survived a median of 96 months. Of 35 patients with recurrent superficial bladder tumors 92% and 56% survived who underwent cystectomy less than 2 years after initial BCG therapy and after 2 years of followup, respectively. Of 55 patients with recurrent muscle invasive bladder disease 41% and 18% survived when cystectomy was performed within and after 2 years, respectively. Multivariate analysis showed that survival was improved in patients who underwent earlier rather than delayed cystectomy for nonmuscle invasive tumor relapse.
  
  
  CONCLUSIONS
  Earlier cystectomy improves the long-term survival of patients with high risk superficial bladder tumors in whom BCG therapy fails.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Herr
authors.forename: P C
authors.initials: PC
authors.lastname: Sogani
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001500:BCG Vaccine / Q000627:therapeutic use; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine