title: Stage pT0 at radical cystectomy confers improved survival: an international study of 4,430 patients.
abstract: OBJECTIVE
  We describe the cancer related outcome in patients with pT0 bladder urothelial carcinoma at radical cystectomy who did not receive preoperative chemotherapy in a large multicenter series. We also compared outcomes in patients with pT0 bladder urothelial carcinoma to those in patients with other stages and assessed the effect of clinical stage on outcome.
  
  
  METHODS
  We reviewed the records of 4,430 patients treated with radical cystectomy for bladder urothelial carcinoma without neoadjuvant chemotherapy at 12 centers in the United States, Canada and Europe.
  
  
  RESULTS
  Of the patients 228 (5.1%) had pT0 disease at radical cystectomy. Clinical stage was cTa or cTis in 13.6% and cT1 in 29.8% of these patients, and disease was muscle invasive (cT2-4a) in 56.2%. Metastasis developed to regional lymph nodes in 17 cases (7.5%). At a median 48.2-month followup 15 patients (6.6%) had died of bladder cancer. Five-year recurrence-free and cancer specific survival estimates were 89.7% (95% CI 85.3-93.1) and 93.1% (95% CI 88.9-95.6), respectively. Disease-free and cancer specific survival in pT0 cases was similar to that in pTa/pTis cases but significantly better than in pT1 or pT2 cases. On multivariate analysis increased disease recurrence and cancer specific mortality risks were significantly associated with lymph node metastasis (each p <0.001) and female gender (p <0.001 and 0.013, respectively).
  
  
  CONCLUSIONS
  Although stage pT0 at radical cystectomy confers a benefit in survival, some patients experience disease recurrence and eventual death. Identifying these patients may help tailor postoperative decision making in patients with pT0.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Michael
authors.initials: M
authors.lastname: Seitz
authors.forename: Guilherme
authors.initials: G
authors.lastname: Godoy
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Izawa
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
authors.forename: Mark
authors.initials: M
authors.lastname: Schoenberg
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.forename: Eila
authors.initials: E
authors.lastname: Skinner
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*