title: Prognostic factors in patients with stage pT0/pT1/pTa in the radical cystectomy specimen.
abstract: OBJECTIVE
  To identify risk factors for progression in patients with invasive bladder carcinoma who were pT0/pT1/pTa after cystectomy.
  
  
  METHODS
  We analyzed the clinical records of 97 post-cystectomy pT0/pT1/pTa patients for the following variables: hydronephrosis, carcinoma in situ (CIS), lymphovascular invasion, history of non-muscular invasive disease, residual tumor in the specimen and lymphatic invasion (pN). pN+patients were excluded from definitive analysis. The quantitative and qualitative variables were analyzed using standard statistics. The chi-square test was used to analyze associations between categorical variables. Univariate Cox proportional hazard regression analysis (enter method) was performed. The Kaplan-Meier method was used to evaluate survival and the log-rank test to assess differences between groups. Statistical significance was set at p<0.05. The analysis was performed using SPSS version 15.0.
  
  
  RESULTS
  The study sample included 97 cases. The specimen was staged at T2 in 97% of patients after transurethral resection (TUR); After cystectomy, the specimen was staged as pT0 (R0) in 44.3% and pT1/Ta (R1) in 55.7%. Median follow-up was 47 months. Lymph node metastasis were detected in 5.2% of patients (pN+rpar; and had a negative impact on survival (p=0.02). Overall survival was 59.8% and cancer-specific survival 76.6%. Univariate analysis showed a relationship between tumor progression and the presence of CIS (p < 0.001), lymphovascular invasion (p=0.049), and hydronephrosis(p < 0.001). In the multivariate analysis, only the presence of CIS in the transurethral resection was associated with reduced cancer-specific survival (HR 100.5; 95% CI, 10.8 to 933.1; pp<0.001).
  
  
  CONCLUSIONS
  Although the prognosis of stage pT0/pT1/pTa carcinoma in the cystectomy specimen is excellent, some patients experience progression. The presence of CIS in the transurethral resection was an independent predictor of recurrence in these cases.
authors.affiliation: Servicio de Urologia.Hospital General Universitario Gregorio Marañon. Madrid.Spain.
authors.forename: Adrián
authors.initials: A
authors.lastname: Husillos-Alonso
authors.forename: Felipe
authors.initials: F
authors.lastname: Herranz Amo
authors.forename: David
authors.initials: D
authors.lastname: Subirá-Ríos
authors.forename: José María
authors.initials: JM
authors.lastname: Díez-Cordero
authors.forename: Mercedes
authors.initials: M
authors.lastname: Moralejo-Gárate
authors.forename: Esther
authors.initials: E
authors.lastname: López-López
authors.forename: Javier
authors.initials: J
authors.lastname: Piñero-Sánchez
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ogaya Pinies
authors.forename: Enrique
authors.initials: E
authors.lastname: Lledó-García
authors.forename: Carlos
authors.initials: C
authors.lastname: Hernández-Fernández
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*