title: [Does a pT0 cystectomy specimen imply being tumour-free in the long term?].
abstract: OBJECTIVE
  The aim of this study was to evaluate the progress of patients with a pT0 radical cystectomy specimen in order to know what factors are helpful in deciding when the bladder can be preserved.
  
  
  METHODS
  We reviewed 153 cases of radical cystectomies performed due to bladder tumours without neoadjuvant therapy between 1995 and 2005 and with a minimum of three years of follow-up. Stage pT0 patients were selected. We considered age at time of diagnosis, sex, pathological stage and grade of the tumour at the time of transurethral resection (TUR), number of resections, surgical factors, tumour characteristics (multifocal, papillary or solid), progression-free survival, cancer-specific survival and cause of death. We ran a univariate analysis of the different factors studied along with disease progression.
  
  
  RESULTS
  12.8% of cystectomy specimens were pT0N0. Progression occurred in 35% between 6 months and 4 years after the cystectomy. Cancer-specific survival was 75%. Five patients died within an average of 18 months. The cause of death for all of them was tumour progression with distant metastasis. Statistical studies in the univariate analysis were only related to progression and the number of prior TURs, which is probably due to the number of cases, but the tumour multifocality, grade and stage were noteworthy. 15% of the pT0 patients had a papillary phenotype and 33% of them died. Of those with a non-papillary phenotype, 23.5% died.
  
  
  CONCLUSIONS
  A stage pT0N0 cystectomy specimen does not define this surgery as curative, and these cases require the same follow-up as for the rest of the patients. It is of particular interest that out of all of our cases, there was no local recurrence, but there was distant metastasis. This leads us to believe that these patients could have benefitted from systemic chemotherapy with no need for radical surgery. In our study, the number of previous relapses was the only prognostic factor with statistical significance.
authors.affiliation: Servicio de Urología, Universidad del País Vasco, Hospital de Basurto, Bilbao, Vizcaya, España. ana.loizagairiarte@osakidetza.net
authors.forename: Ana
authors.initials: A
authors.lastname: Loizaga Iriarte
authors.forename: Nerea
authors.initials: N
authors.lastname: Senarriaga Ruiz de la Illa
authors.forename: Isabel
authors.initials: I
authors.lastname: Lacasa Viscasillas
authors.forename: Ainara
authors.initials: A
authors.lastname: Rábade Ferreiro
authors.forename: Iñaki
authors.initials: I
authors.lastname: Iriarte Soldevilla
authors.forename: Miguel
authors.initials: M
authors.lastname: Unda Urzaiz
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*