title: Radical cystectomy for clinically muscle invasive bladder cancer: does prior non-invasive disease affect clinical outcomes?
abstract: OBJECTIVE
  To compare clinical and pathologic outcomes of radical cystectomy for muscle invasive bladder cancer in relation to prior history of non-invasive urothelial carcinoma.
  
  
  METHODS
  Retrospective data collected from 1,150 patients managed by radical cystectomy for urothelial carcinoma of the bladder from the Canadian Bladder Cancer Network were analysed. Patients with clinical stage T2 or more were included and divided into two groups: (Group 1) patients with prior history of non-invasive urothelial carcinoma (N = 365) and (Group 2) patients with clinical muscle invasive cancer de novo (N = 785). Variables analysed included patient age, gender, pathologic stage, adjuvant chemotherapy, recurrence and mortality.
  
  
  RESULTS
  Both groups were nearly equal in mean age and gender distribution, with mean ages of 67.2 and 66.7 years, and 79.7 and 79.5%, respectively (P = 0.4 and 0.9, respectively). The presence of preoperative hydronephrosis was 20.8 and 32.6% (P = 0.0007) for groups 1 and 2, respectively. The rate of higher pathological stage (T3 or T4) was 36.3 and 58% (P < 0.0001), positive lymph nodes were 20.1 and 28.8% (P = 0.002), and lymphovascular invasion was 31.7 and 46.2% (P = 0.0001) for groups 1 and 2, respectively. The rate of adjuvant chemotherapy was 15.5 and 23.3% (P = 0.002) for groups 1 and 2, respectively. None of the sampled patients received neoadjuvant chemotherapy. The overall survival (OS) and disease-specific survival (DSS) rates at 5 years were 62 and 70% for group 1 and 51 and 60% for group 2, respectively, while at 10 years, OS and DSS were 46 and 66% for group 1 and 35 and 49% for group 2, respectively (P = 0.0001 and 0.0002, respectively). Using multivariate analysis examining factors affecting recurrence and survival, we found that previous non-invasive bladder tumour history was associated with a significantly reduced risk of mortality and recurrence (Hazard ratio of 0.7 for all risks, P = 0.0002).
  
  
  CONCLUSIONS
  Our retrospective study suggests that patients with non-invasive urothelial carcinoma of the bladder that progress to muscle invasion and require radical cystectomy appear to have better pathologic and clinical outcome than patients presenting with clinical muscle invasive disease de novo.
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, QC, Canada. drahmedfali@gmail.com
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Kotb
authors.forename: Evan
authors.initials: E
authors.lastname: Kovac
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Joe
authors.initials: J
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: Armen G
authors.initials: AG
authors.lastname: Aprikian
mesh_terms: D000367:Age Factors; D000368:Aged; D002170:Canada; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D019459:Urothelium / Q000473:pathology