title: Multicenter evaluation of the prognostic value of pT0 stage after radical cystectomy due to urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  •To evaluate the characteristics and long-term outcome of patients with pT0 stage after radical cystectomy (RC) for urothelial carcinoma of the urinary bladder (UCB).
  
  
  METHODS
  •Clinical and pathological records of 2403 patients treated with RC for UCB were collected in a multi-institutional database. •The patients met the following criteria: clinical tumour stage cTa-cT2, cN0, cM0, no neoadjuvant chemotherapy or radiotherapy. •Overall (OS) and cancer-specific survival rates (CSS) were calculated for the various clinical tumour stages in relation to their corresponding pathological tumour stage in the RC sample. •Further to this, a multivariable prediction model was developed based on the available clinical data to estimate the probability of tumour stage pT0.
  
  
  RESULTS
  •The mean follow-up was 53 months and 132 patients (5.5%) were stage pT0. •Patients with stage cT2-pT0 had a 5-year CSS of 87% vs 69% for cT2-pT2 (P= 0.012) and 57% for cT2-pT+ (P < 0.001). •In a multivariable Cox-model, stage pT0 led to a significant reduction of cancer-specific mortality (hazard ratio0.27; 95% confidence interval 0.12-0.61). •A logistical regression model identified clinical tumour stage (advantage for non-invasive stages) and transurethral resection of the urinary bladder (TURB) time frame (advantage for more recent surgery) as independent predictors for stage pT0.
  
  
  CONCLUSIONS
  •In muscle-invasive clinical tumour stages, patients with pathological tumour stage pT0 form a subgroup showing a significantly better CSS. •A radical TURB is, assumedly, not causative of this improved survival rate, but rather it is that individual tumour characteristics allow for complete tumour eradication through the TURB procedure. •A TURB with R0 resection is, as such, only a sign of a better tumour prognosis.
authors.affiliation: Department of Urology, St. Elisabeth Klinikum, Straubing LMU München, München, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Lutz
authors.initials: L
authors.lastname: Trojan
authors.forename: Edwin
authors.initials: E
authors.lastname: Herrmann
authors.forename: Christian
authors.initials: C
authors.lastname: Wülfing
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Müller
authors.forename: Jörg
authors.initials: J
authors.lastname: Ellinger
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Otto
authors.forename: Thomas
authors.initials: T
authors.lastname: Höfner
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.forename: Mario
authors.initials: M
authors.lastname: Zacharias
authors.forename: Wolf F
authors.initials: WF
authors.lastname: Wieland
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*