title: Contemporary outcomes of 2287 patients with bladder cancer who were treated with radical cystectomy: a Canadian multicentre experience.
abstract: Study Type -Therapy (case series).
  
  
  METHODS
  4.
  
  
  OBJECTIVE
  To evaluate data obtained from a large, multi-institutional, contemporary series of patients who underwent radical cystectomy (RC) in a universal healthcare system aiming to assess outcome and identify novel prognostic variables.
  
  
  METHODS
  Data were collected and pooled from 2287 patients treated with RC between 1998 and 2008 by urological oncologists from eight Canadian academic centres. Collected variables included various clinicopathological parameters, recurrence and death. Survival and prognostic variables were analyzed using the Kaplan-Meier method and Cox regression analysis.
  
  
  RESULTS
  The median age of patients was 68 years with a mean (median) follow-up time of 35 (29) months. The 30, 60 and 90-day postoperative mortality rates were 1.3%, 2.6% and 3.2%, respectively. The 5-year overall, recurrence-free and cancer-specific survival was 57%, 48% and 67%, respectively, with a local recurrence rate of 6%. Pathological stage distribution was <pT2N0, n = 498 (23%); pT2N0, n = 365 (17%); pT3N0, n = 463 (21%); pT4N0, n = 170 (8%); and pTxN+, n = 507 (23%). Only 3.1% of patients received neoadjuvant chemotherapy and 19.4% received adjuvant chemotherapy. On multivariate analysis, lower pathological stage, negative surgical margins, receipt of adjuvant chemotherapy, performance of pelvic lymphadenectomy and an absence of smoking were associated with prolonged disease-specific and overall survival.
  
  
  CONCLUSIONS
  RC performed at academic centres provides excellent local control of disease and an acceptable clinical outcome with low perioperative mortality in patients who are treated within a universal healthcare system. Smoking, pelvic lymphadenectomy and receipt of adjuvant chemotherapy are independent prognostic factors for survival. Neoadjuvant chemotherapy continues to be under-utilized in Canada.
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, Canada.
authors.forename: Faysal A
authors.initials: FA
authors.lastname: Yafi
authors.forename: Armen G
authors.initials: AG
authors.lastname: Aprikian
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Jonathan
authors.initials: J
authors.lastname: Izawa
authors.forename: Eric
authors.initials: E
authors.lastname: Estey
authors.forename: Adrian
authors.initials: A
authors.lastname: Fairey
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rendon
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Lattouf
authors.forename: David
authors.initials: D
authors.lastname: Bell
authors.forename: Darrel
authors.initials: D
authors.lastname: Drachenberg
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant / Q000401:mortality; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion / Q000706:statistics & numerical data