title: Oncological outcome of primary versus secondary muscle-invasive bladder cancer is comparable after radical cystectomy.
abstract: BACKGROUND
  High-risk non-muscle-invasive bladder cancer (NMIBC) progressing to muscle-invasive bladder cancer (MIBC) is associated with adverse tumour biology. It is unclear, however, whether outcome of NMIBC progressing to MIBC is adverse compared to primary MIBC and whether NMIBC of higher risk of progression to MIBC is adverse compared to NMIBC of lower risk.
  
  
  OBJECTIVE
  Our objective was to assess cancer-specific survival (CSS) following radical cystectomy (RC) for primary MIBC and for NMIBC progressing to MIBC in dependence of EORTC risk score.
  
  
  METHODS
  Clinical and histopathological characteristics and CSS of 150 patients were assessed. Secondary MIBCs were stratified by EORTC risk score at the last transurethral resection of bladder tumour for NMIBC.
  
  
  RESULTS
  CSS did not differ significantly between primary and secondary MIBC (p = 0.521). Secondary MIBC with high EORTC score had significantly shorter CSS compared to secondary MIBC with intermediate EORTC score (p = 0.029). In multivariable analysis, pathological tumour stage (HR = 3.77; p = 0.020) and lymph node stage (HR = 2.34; p = 0.022) were significantly correlated with CSS.
  
  
  CONCLUSIONS
  While the outcome of secondary MIBC is not generally adverse compared to primary MIBC, the EORTC risk score not only reflects high risk of progression of NMIBC to MIBC, but also worse outcome following RC for secondary MIBC. Timely RC should thus be debated in high-risk NMIBC.
authors.affiliation: Department of Urology, Caritas-St. Josef Medical Centre, University of Regensburg, Germany. atiqullah.aziz@klinikum.uni-regensburg.de
authors.forename: A
authors.initials: A
authors.lastname: Aziz
authors.forename: M
authors.initials: M
authors.lastname: Gierth
authors.forename: H M
authors.initials: HM
authors.lastname: Fritsche
authors.forename: M
authors.initials: M
authors.lastname: May
authors.forename: W
authors.initials: W
authors.lastname: Otto
authors.forename: S
authors.initials: S
authors.lastname: Denzinger
authors.forename: W F
authors.initials: WF
authors.lastname: Wieland
authors.forename: A
authors.initials: A
authors.lastname: Merseburger
authors.forename: H
authors.initials: H
authors.lastname: Riedmiller
authors.forename: A
authors.initials: A
authors.lastname: Kocot
authors.forename: M
authors.initials: M
authors.lastname: Burger
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009132:Muscles / Q000473:pathology; D009361:Neoplasm Invasiveness; D011336:Probability; D016016:Proportional Hazards Models; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery* / Q000628:therapy