title: Radical cystectomy in a Dutch University hospital: long-term outcomes and prognostic factors in a homogeneous surgery-only series.
abstract: BACKGROUND
  The aim of this study was to present survival outcomes and identify prognostic factors in patients undergoing radical cystectomy (RC) for urothelial bladder cancer (UBC) in a homogeneous surgery-only series.
  
  
  METHODS
  Patients who underwent RC for UBC with intent-to-cure between January 1998 and December 2010 without neoadjuvant or adjuvant treatment were included in this retrospective study. Clinical and histopathologic data were collected and institutional review board approval was obtained. Outcomes of interest were 30-day mortality (30dM), RFS, and OS. Univariable and multivariable analysis were performed. Median follow-up was 9.1 years.
  
  
  RESULTS
  Two hundred forty-five patients were included with a median age of 65 years (range, 34-92 years). 30dM rate was in 5 out of 245 patients (2.0%) and 5-year RFS and OS rates were 67% and 58%, respectively. A total of 223 patients (91%) underwent lymph node (LN) dissection. Median number of removed and positive LNs were 9 and 1.5, respectively. Variables independently associated with decreased OS and RFS were tumor stage and LN status. In addition, positive soft tissue surgical margin (STSM) status was independently associated with decreased OS. In LN-positive patients, presence of extranodal extension (ENE) was associated with decreased RFS (39.7% vs. 7.3%; P = .005).
  
  
  CONCLUSIONS
  Radical cystectomy for UBC was associated with low perioperative mortality rate and provided 5-year disease control in approximately two-thirds of patients. Independent prognostic factors included tumor stage, LN status (RFS and OS), and STSM status (OS). Presence of ENE in LN-positive patients was univariably associated with decreased RFS and OS.
authors: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Harman M
authors: HM
authors: Bruins
authors: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Tom J H
authors: TJ
authors: Arends
authors: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Mijke
authors: M
authors: Pelkman
authors: Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Christina A
authors: CA
authors: Hulsbergen-van de Kaa
authors: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Antoine G
authors: AG
authors: van der Heijden
authors: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: f.witjes@radboudumc.nl.
authors: J Alfred
authors: JA
authors: Witjes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Clinical outcome; Lymph node dissection; Muscle-invasive bladder cancer; Urinary bladder cancer; Urothelial carcinoma