title: Effect of Stage Migration on Bladder Cancer: A Slow but Steady Improvement in Long-Term Survival Rates After Radical Cystectomy in Previous 25 Years.
abstract: We evaluated the effect of the year of surgery on the clinical, pathologic, and oncologic outcomes of patients with bladder cancer (BCa) treated with radical cystectomy (RC) at a single institution.
  
  
  
  The present study included 1253 consecutive patients with BCa treated with RC and extended pelvic lymphadenectomy at a single institution from January 1990 to December 2014. Analysis of variance and χ2trend tests were used to report the clinical and pathologic characteristics of the cohort over time. Multivariable Cox regression analysis was used to test the relationship between the year of surgery and recurrence, cancer-specific mortality (CSM) and overall mortality (OM).
  
  
  
  Considering the clinical characteristics, patient age (P = .1) and gender (P = .2) remained steady during the study period. In contrast, the body mass index (P < .005) increased. Also, of the pathologic features, carcinoma in situ detection (P < .001) showed an increasing rate, and pathologic stage T3-T4 (P = .005) showed a decreasing trend. The number of lymph nodes removed increased during the study period (P < .001), resulting in an increased number of positive nodes (P < .001). However, the rate of lymph node invasion (P = .1) remained stable in the overall population. Multivariable Cox regression analyses revealed the year of surgery as a predictor of recurrence (hazard ratio [HR], 0.97), CSM (HR, 0.97), and OM (HR, 0.98), with a slight, but constant, reduction in all survival outcomes (P < .04 for all).
  
  
  
  Changes were recorded considering the patient and tumor characteristics across the previous 25 years. These variations directly reflect the differences in long-term survival expectations we recorded.
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: marco.moschini87@gmail.com.
authors: Marco
authors: M
authors: Moschini
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors: Stefano
authors: S
authors: Luzzago
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors: Walter
authors: W
authors: Cazzaniga
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors: Vito
authors: V
authors: Cucchiara
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors: Marco
authors: M
authors: Bandini
authors: Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors: Rocco
authors: R
authors: Damiano
authors: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors: Francesco
authors: F
authors: Soria
authors: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors: Tobias
authors: T
authors: Klatte
authors: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors: Andrea
authors: A
authors: Salonia
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors: Francesco
authors: F
authors: Montorsi
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors: Alberto
authors: A
authors: Briganti
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors: Renzo
authors: R
authors: Colombo
authors: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors: Andrea
authors: A
authors: Gallina
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010388:Pelvis; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: BMI; Bladder cancer; Pathological stage; Radical cystectomy; Stage migration