title: Residual pathological stage at radical cystectomy significantly impacts outcomes for initial T2N0 bladder cancer.
abstract: OBJECTIVE
  We hypothesized that in patients with T2N0 stage disease at transurethral bladder tumor resection a lower residual cancer stage (P1N0 or less) at radical cystectomy may correlate with improved outcomes relative to those with residual P2N0 disease.
  
  
  METHODS
  We analyzed 208 patients with T2N0 stage disease at transurethral bladder tumor resection whose tumors were organ confined at radical cystectomy (P2 or lower, pN0). None received perioperative chemotherapy. Kaplan-Meier as well as univariable and multivariable Cox regression models addressed the effect of residual pT stage at radical cystectomy on recurrence and cancer specific mortality rates. Covariates consisted of age, gender, grade, lymphovascular invasion, carcinoma in situ, number of lymph nodes removed and year of surgery.
  
  
  RESULTS
  Residual pT stage at radical cystectomy was P0 in 24 (11.5%) patients, Pa in 9 (4.3%), PCIS in 22 (10.6%), P1 in 35 (16.8%) and P2 in 118 (56.7%). Median followup of censored patients was 55.7 months for recurrence and 52.1 months for cancer specific mortality analyses. The 5-year recurrence-free survival rates of patients with P0/Pa/PCIS, P1 and P2 stage disease were 100%, 85% and 75%, respectively. The 5-year cancer specific survival rates for the same cohorts were 100%, 93% and 81%, respectively. On multivariable analysis the effect of residual stage P1 or lower at radical cystectomy achieved independent predictor status for recurrence (adjusted HR 0.20, p = 0.002) and cancer specific mortality (adjusted HR 0.24, p = 0.02).
  
  
  CONCLUSIONS
  Down staging from initial T2N0 bladder cancer at transurethral bladder tumor resection to lower stage at radical cystectomy significantly reduces recurrence and cancer specific mortality. Further validation of this finding is warranted.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Centre, Montréal, Quebec, Canada.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Ganesh S
authors.initials: GS
authors.lastname: Palapattu
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Mark P
authors.initials: MP
authors.lastname: Schoenberg
authors.forename: Gilad E
authors.initials: GE
authors.lastname: Amiel
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*