title: A delay in radical cystectomy of >3 months is not associated with a worse clinical outcome.
abstract: OBJECTIVE
  To examine the association between the interval from the last transurethral resection (TUR) to radical cystectomy (RC) and bladder cancer-specific outcome, as the decision to proceed to RC for an individual patient is complex, and recent reports suggest an interval from diagnosis to RC of >3 months is associated with adverse outcomes.
  
  
  METHODS
  The records of 592 patients who had RC were reviewed; the interval from the last TUR was analysed as both a continuous and categorical variable (<3 vs >/=3 months). Logistic regression and survival analyses were used to evaluate the association between the interval to RC with pathological characteristics and clinical outcomes.
  
  
  RESULTS
  The mean (sd) actuarial cancer-specific survival was 70.5 (2.3)% and 60.7 (3.2)% at 3 and 7 years, respectively. Overall, the median (range) time from TUR to RC was 1.8 (0.3-11.6) months. The interval to RC analysed as a continuous or categorical variable was not associated with extravesical or nodal disease, lymph node metastases, disease recurrence, overall or cancer-specific survival. The results were similar in the subgroup of 320 patients (54%) with clinically muscle-invasive disease.
  
  
  CONCLUSIONS
  These results suggest that a reasonable delay from the last TUR to RC is not independently associated with stage progression or with decreased recurrence-free or disease-specific survival. These findings might have important implications for trial design in the ongoing evaluation of neoadjuvant regimens. Nevertheless, we see no reason to advocate anything less than the timely consideration of definitive treatment for patients with high-risk bladder cancer.
authors.affiliation: The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.forename: Ganesh S
authors.initials: GS
authors.lastname: Palapattu
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Mark P
authors.initials: MP
authors.lastname: Schoenberg
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*