title: Predictive factors of evolution of patients after pT0 radical cystectomy due to bladder cancer.
abstract: OBJECTIVE
  To analyze the influence of the different pre - cystectomy factors, both clinical and pathological, in the follow up of patients with no residual tumor ( pT0) in the pathological examination of the radical cystectomy specimen as predictors of tumor recurrence. Secondly we intend to compare overall survival, disease free survival and cancer-specific survival with the rest of cystectomy patients in our series.
  
  
  METHODS
  Between 1985 and 2010, radical cystectomy was performed in 280 patients with bladder cancer, being 41 pT0 (14.6%). We analyzed potential predictors for overall survival and disease-free survival: age, sex , number of transurethral resections of bladder tumor before cystectomy , tumor type , tumor grade, tumor stage, tumor size, number of tumors, associated Cis and previous instillations. We used univariate analysis of Cox regression. Survival analysis was performed using Kaplan - Meier curves and log-rank test.
  
  
  RESULTS
  Mean age was 61.7 years and 37 patients were males (90.2%). Stages before cystectomy were pT1 in eight (19.5%) , pT2 in 31 (75.6%) and Cis in two (4.9 %) with tumor grade III in 37 (90.2%). Cystectomy specimens revealed the presence of papillary transitional cell carcinoma in 38 (92.7%) cases. The median number of pre-cistectomy-TURBT was one. Eleven patients (26.8%) received intravesical instillations. Six patients (14.63 %) had tumor recurrence and 10 (24.4 %) died from causes unrelated to the disease. None of the variables analyzed was statistically significant in the univariate analysis as a predictor of tumor recurrence. With a median follow up of 70 months (3-272) disease-free survival and overall survival at five years were 85.9% and 72.8% respectively. Compared to the non pT0 cystectomies in our series, pT0 had a statistically significant difference for better recurrence-free survival (63.4 % and 36.8%, respectively in pT0 and no-pT0 patients) (p〈0,05).
  
  
  CONCLUSIONS
  According to the results, we have found a better outcome for pT0 patients after cystectomy compared to those with residual tumor. We have not found any pre - cystectomy predictive factor related to disease-free survival and overall survival.
authors.affiliation: Servicio de Urología. Hospital Universitario "Marques De Valdecilla". (HUMV). Santander. España.
authors.forename: E
authors.initials: E
authors.lastname: Mediavilla
authors.forename: J A
authors.initials: JA
authors.lastname: Portillo
authors.forename: D
authors.initials: D
authors.lastname: Truán
authors.forename: F
authors.initials: F
authors.lastname: Campos-Juanatey
authors.forename: L
authors.initials: L
authors.lastname: Gala
authors.forename: J
authors.initials: J
authors.lastname: Fuentes
authors.forename: C
authors.initials: C
authors.lastname: Carrión
authors.forename: J L
authors.initials: JL
authors.lastname: Gutiérrez
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000601:surgery; D015653:Cystectomy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000601:surgery