title: Survival after cystectomy for invasive bladder cancer.
abstract: OBJECTIVE
  To determine the difference in survival after cystectomy between patients presenting with primary muscle infiltrating bladder cancer and patients with progression to muscle infiltration after treatment for initial non-muscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  We retrospectively analyzed the files of 188 patients who underwent cystectomy for transitional cell carcinoma between 1987 and 2005. Two groups were defined: patients presenting with muscle-invasive tumours and those progressing to muscle invasion after initial treatment. This second group was further divided into low-intermediate and high risk according to the EAU grouping for NMIBC.
  
  
  RESULTS
  The 5-year disease specific survival (95% confidence intervals) for all patients was 50%(42-59%); 49%(40-60%) in the primary muscle infiltrating group and 52%(37-74%) in the progressive group (p = ns). The 5-year disease specific survival in the progressive group according to EAU risk groups was 75%(58-97%) for the initially diagnosed low-intermediate risk tumours and 35%(17-71%) for the initially diagnosed high-risk tumours (p = 0.015). The percentage of patients with non-locally confined tumours (pT3/4-N0//any pT-N+) was 31%//45% and 24%//46% in the primary muscle infiltrating and progressive group, respectively.
  
  
  CONCLUSIONS
  Despite close observation of patients treated for non-muscle-invasive bladder cancer, the survival of patients who progress to muscle invasion is not better than survival of patients presenting with primary muscle infiltrating cancer. Patients with high-risk non-invasive tumours (EAU risk-categories) who progress to muscle-invasive disease have a worse prognosis compared to patients with low or intermediate risk tumours.
authors.affiliation: Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: R R
authors.initials: RR
authors.lastname: de Vries
authors.forename: J A
authors.initials: JA
authors.lastname: Nieuwenhuijzen
authors.forename: A
authors.initials: A
authors.lastname: Vincent
authors.forename: H
authors.initials: H
authors.lastname: van Tinteren
authors.forename: S
authors.initials: S
authors.lastname: Horenblas
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000401:mortality / Q000473:pathology*; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery