title: Outcomes of radical cystectomy and bladder preservation treatment for muscle-invasive urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  To compare the survival outcome of various treatment modalities for organ-confined muscle-invasive urothelial carcinoma of the bladder.
  
  
  METHODS
  One hundred and fifty patients with Stage II (T2, N0, M0) or Stage III (T3a-T4a, N0, M0) urothelial carcinoma of the bladder treated at the National Referral Hospital and the National Cancer Center of Indonesia from 1995 to 2010 with a minimum follow-up period of 24 months were included in this study. Overall survival and mean survival times were analyzed using the Kaplan-Meier method.
  
  
  RESULTS
  The mean ± standard deviation age of the patients in this study was 57.15 ± 11.6 years and 88% were men. Over 50% of patients had T2 disease, 24.2% had T3 disease, and 21.5% had T4 disease based on pathology. Based on histological grade, 30.8% were intermediate grade tumors and 42.1% were high-grade tumors. Radical cystectomy was performed in 20 patients (13.3%) and 40 patients (26.7%) were treated with radiotherapy. Ninety (60%) patients underwent transurethral resection of the bladder tumor only without further definitive treatment for personal reasons. The actuarial 5-year overall survival for all patients was as follows: radical cystectomy, 50%; radiotherapy, 22.7%; and transurethral resection of the bladder tumor only, 8.3% (log-rank p = 0.029). For stage T2 patients, the 5-year overall survival was: radical cystectomy, 62.5%; radiotherapy, 31.2%; and transurethral resection of the bladder tumor only, 8.3% (log-rank p = 0.017).
  
  
  CONCLUSIONS
  In our series, radical cystectomy had a superior outcome to radiotherapy or transurethral resection of the bladder tumor only, comparable with results reported elsewhere. Radical cystectomy should be offered as the gold standard treatment for organ-confined muscle-invasive urothelial carcinoma of the bladder.
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia. Electronic address: wemsupit@gmail.com.
authors.forename: Wempy
authors.initials: W
authors.lastname: Supit
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia.
authors.forename: Chaidir Arif
authors.initials: CA
authors.lastname: Mochtar
authors.affiliation: Department of Urology, Dharmais National Cancer Center, Jakarta, Indonesia.
authors.forename: Rachmat Budi
authors.initials: RB
authors.lastname: Santoso
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia.
authors.forename: Rainy
authors.initials: R
authors.lastname: Umbas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: invasive bladder cancer; radical cystectomy; radiotherapy; survival; transurethral resection; urothelial carcinoma