title: Comparing long-term outcomes of primary and progressive carcinoma invading bladder muscle after radical cystectomy.
abstract: OBJECTIVE
  To assess the impact of primary or progressive status on recurrence-free survival (RFS), cancer-specific mortality (CSM) and overall mortality (OM) after radical cystectomy (RC) for muscle- invasive bladder cancer (MIBC).
  
  
  METHODS
  A total of 768 consecutive patients underwent RC as treatment for MIBC at our institution between 2000 and 2012. Primary MIBC was defined as no previous history of bladder cancer and progressive was defined as recorded previous treated non-MIBC (NMIBC) that had progressed to MIBC. The median follow-up was 85 (60-109) months. Univariate and multivariate Cox regression models were used to compare RFS, CSM and OM between these two cohorts.
  
  
  RESULTS
  In all, 475 (61.8%) patients had primary and 293 (38.2%) patients had progressive MIBC. There were no differences between the two groups in terms of demographics, pathological and peri-operative complications (all P > 0.1). The 10-year RFS, CSM and OM rates for primary vs progressive status were 43 vs 36% (P = 0.01), 43 vs 37% (P = 0.01), and 35 vs 28% (P = 0.03), respectively. On multivariable Cox regression analyses, progressive status remained significantly associated with a higher rate of recurrence (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.12-1.79; P = 0.03), CSM (HR 1.42, 95% CI 1.07-1.89; P = 0.01) and OM (HR1.42, 95% CI 1.13-1.65; P = 0.02).
  
  
  CONCLUSIONS
  Among patients treated with RC for MIBC, progressive status was associated with a higher CSM, OM and recurrence rate after RC. The present study thus provides an impetus to improve risk sub-stratification when bladder cancer is still at the NMIBC stage, be it through new biomarkers or improved imaging, as a subset of patients with NMIBC are likely to benefit from early RC.
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.|Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors: Marco
authors: M
authors: Moschini
authors: Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA.
authors: Vidit
authors: V
authors: Sharma
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Paolo
authors: P
authors: Dell'oglio
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Vito
authors: V
authors: Cucchiara
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Giorgio
authors: G
authors: Gandaglia
authors: Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors: Francesco
authors: F
authors: Cantiello
authors: Department of Urology, University of Padua, Padua, Italy.
authors: Fabio
authors: F
authors: Zattoni
authors: Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors: Federico
authors: F
authors: Pellucchi
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Alberto
authors: A
authors: Briganti
authors: Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors: Rocco
authors: R
authors: Damiano
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Francesco
authors: F
authors: Montorsi
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Andrea
authors: A
authors: Salonia
authors: Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Renzo
authors: R
authors: Colombo
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: bladder cancer; muscle invasive; primary; progressive; radical cystectomy