Muscle-invasive bladder cancer: predictive factors and prognostic difference between primary and progressive tumors.
OBJECTIVE
To establish whether a difference in the clinical outcomes of patients with progressive and primary muscle-invasive bladder cancer exists.


METHODS
The records of patients who had undergone radical cystectomy for bladder urothelial carcinoma from 1990 to 2005 were reviewed. According to our inclusion criteria, 109 patients with primary muscle-invasive tumor (group 1) and 45 patients with progressive tumors were selected (group 2). The correlation of clinical and pathologic variables with survival was investigated using the Cox proportional hazards test. The Kaplan-Meier method was used to estimate progression rates. Multivariate analysis was performed using the Cox regression survival method to investigate possible predictive factors.


RESULTS
The 2, 3, and 5-year cancer-specific survival rate was 72%, 61%, and 43% for patients with progressive tumor and 75%, 62%, and 54% for patients with primary tumor, respectively (P >0.05). For lymph node-negative tumors (pN0), the corresponding rates were 77%, 64%, and 56% in group 1 and 73%, 60%, and 39% in group 2 (P >0.05). On multivariate analysis, lymphovascular invasion and pT stage of the primary tumor remained significant independent prognostic factors for cancer-specific survival. The detection of local and/or distant metastasis during follow-up significantly shortened the cancer-specific survival of patients with muscle-invasive bladder cancer.


CONCLUSIONS
The results of our study have shown that patients with progressive muscle-invasive urothelial tumors do not have a worse prognosis than do those with primary tumors. During the early postoperative years, even patients with progressive tumors had better disease-specific survival rates. For both groups, pT stage and lymphovascular invasion seemed to be independent predictors of decreased cancer-specific survival.
Türkölmez
Kadir
K
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Tokgöz
Hüsnü
H
Reşorlu
Berkan
B
Köse
Kenan
K
Bedük
Yaşar
Y
D001500:BCG Vaccine / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery
D001500:BCG Vaccine