title: Radical cystectomy for invasive bladder cancer: results of multi-institutional pooled analysis.
abstract: BACKGROUND
  We report the outcome of radical cystectomy for patients with invasive bladder cancer, who did not have regional lymph node or distant metastases, at 21 hospitals.
  
  
  METHODS
  Retrospective, non-randomized, multi-institutional pooled data were analyzed to evaluate outcomes of patients who received radical cystectomy. Between 1991 and 1995, 518 patients with invasive bladder cancer were treated with radical cystectomy at 21 hospitals. Of these, 250 patients (48.3%) received some type of neoadjuvant and/or adjuvant therapy depending on the treatment policy of each hospital.
  
  
  RESULTS
  The median follow-up period was 4.4 years, ranging from 0.1 to 11.4 years. The 5-year overall survival rate was 58% for all 518 patients. The 5-year overall survival rates for patients with clinical T2N0M0, T3N0M0 and T4N0M0 were 67%, 52% and 38%, respectively. The patients with pT1 or lower stage, pT2, pT3 and pT4 disease without lymph node metastasis had 5-year overall survivals of 81%, 74%, 47% and 38%, respectively. The patients who were node positive had the worst prognosis, with a 30% overall survival rate at 5 years. Neoadjuvant or adjuvant chemotherapy did not provide a significant survival advantage, although adjuvant chemotherapy improved the 5-year overall survival in patients with pathologically proven lymph node metastasis.
  
  
  CONCLUSIONS
  The current retrospective study showed that radical cystectomy provided an overall survival equivalent to studies reported previously, but surgery alone had no more potential to prolong survival of patients with invasive cancer. Therefore, a large-scale randomized study on adjuvant treatment as well as development of new strategies will be needed to improve the outcome for patients with invasive bladder cancer.
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Taiji
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Tobisu
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Kazunari
authors.initials: K
authors.lastname: Sato
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Tomita
authors.forename: Shu-ichi
authors.initials: S
authors.lastname: Komatsubara
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishizawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Igarashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujimoto
authors.forename: Hayakazu
authors.initials: H
authors.lastname: Nakazawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Komatsu
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sugimura
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Ono
authors.forename: Masao
authors.initials: M
authors.lastname: Kuroda
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Hirao
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Tsushima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kakehi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.forename: Sho-ichi
authors.initials: S
authors.lastname: Ueda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakagawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*