J Korean Med Sci.  2014 May;29(5):669-675. 10.3346/jkms.2014.29.5.669.

Long-Term Oncologic Outcomes after Radical Cystectomy for Bladder Cancer at a Single Institution

• Kwon T
• Jeong IG
• You D
• Hong B
• Hong JH
• Ahn H
• Kim CS

• KMID: 1786108
• DOI: http://doi.org/10.3346/jkms.2014.29.5.669

Abstract

The aim of this study was to evaluate our experience using radical cystectomy to treat patients with bladder cancer and to describe the associations between pathologic features and clinical outcomes. All 701 patients who underwent radical cystectomy for bladder cancer were evaluated. The patient population consisted of 623 men and 78 women. The overall 5 and 10 yr recurrence-free survival (RFS) rates were 61.8% and 57.7%, respectively, and the 5 and 10 yr cancer-specific survival (CSS) rates were 70.8% and 65.1%, respectively. Multivariate analysis showed that factors significantly predictive of RFS and CSS included extravesical extension (P = 0.001), lymph node metastasis (P = 0.001), and lymphovascular invasion (P < 0.001 and P = 0.007). The 5 and 10 yr RFS rates for patients with lymph node metastasis were 25.6% and 20.8%, respectively, and the 5 and 10 yr CSS rates were 38.6% and 30.9%, respectively. Adjuvant chemotherapy significantly improved RFS (P = 0.002) and CSS (P = 0.001) in patients with lymph node metastasis. Radical cystectomy provides good survival results in patients with invasive bladder cancer. Pathologic features significantly associated with prognosis include extravesical extension, node metastasis, and lymphovascular invasion. Adjuvant chemotherapy improves survival in patients with advanced stage disease.

Keyword

Urinary Bladder Neoplasms; Cystectomy; Prognosis

MeSH Terms

Chemotherapy, Adjuvant
*Cystectomy
Disease-Free Survival
Female
Humans
Lymphatic Metastasis/pathology
Male
Middle Aged
Neoplasm Invasiveness/pathology
Neoplasm Recurrence, Local/pathology
Retrospective Studies
Survival Rate
Treatment Outcome
Urinary Bladder/pathology/*surgery
Urinary Bladder Neoplasms/drug therapy/pathology/*surgery

Figure

• 

  Fig. 1 Kaplan-Meier analysis of survival after radical cystectomy in 178 lymph node metastasis patients. (A) Recurrence-free survival and (B) cancer-specific survival. (C) Recurrence-free survival and (D) cancer-specific survival by lymph node density (LND) 18%. (E) Recurrence-free survival and (F) cancer-specific survival by adjuvant chemotherapy.

Reference

1. Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat. 2013; 45:1–14.

2. Otto W, May M, Fritsche HM, Dragun D, Aziz A, Gierth M, Trojan L, Herrmann E, Moritz R, Ellinger J, et al. Analysis of sex differences in cancer-specific survival and perioperative mortality following radical cystectomy: results of a large German multicenter study of nearly 2500 patients with urothelial carcinoma of the bladder. Gend Med. 2012; 9:481–489.

3. Lynch CF, Cohen MB. Urinary system. Cancer. 1995; 75:316–329.

4. Messing EM, Young TB, Hunt VB, Gilchrist KW, Newton MA, Bram LL, Hisgen WJ, Greenberg EB, Kuglitsch ME, Wegenke JD. Comparison of bladder cancer outcome in men undergoing hematuria home screening versus those with standard clinical presentations. Urology. 1995; 45:387–396.

5. Allard P, Bernard P, Fradet Y, Têtu B. The early clinical course of primary Ta and T1 bladder cancer: a proposed prognostic index. Br J Urol. 1998; 81:692–698.

6. Kurth KH, Denis L, Bouffioux C, Sylvester R, Debruyne FM, Pavone-Macaluso M, Oosterlinck W. Factors affecting recurrence and progression in superficial bladder tumours. Eur J Cancer. 1995; 31A:1840–1846.

7. Parekh DJ, Gilbert WB, Koch MO, Smith JA Jr. Continent urinary reconstruction versus ileal conduit: a contemporary single-institution comparison of perioperative morbidity and mortality. Urology. 2000; 55:852–855.

8. Dutta SC, Chang SC, Coffey CS, Smith JA Jr, Jack G, Cookson MS. Health related quality of life assessment after radical cystectomy: comparison of ileal conduit with continent orthotopic neobladder. J Urol. 2002; 168:164–167.

9. Cho KS, Choi HM, Koo K, Park SJ, Rha KH, Choi YD, Chung BH, Cho NH, Yang SC, Hong SJ. Clinical significance of lymph node dissection in patients with muscle-invasive upper urinary tract transitional cell carcinoma treated with nephroureterectomy. J Korean Med Sci. 2009; 24:674–678.

10. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001; 19:666–675.

11. Ghoneim MA, el-Mekresh MM, el-Baz MA, el-Attar IA, Ashamallah A. Radical cystectomy for carcinoma of the bladder: critical evaluation of the results in 1,026 cases. J Urol. 1997; 158:393–399.

12. Lee K, Jung ES, Choi YJ, Lee KY, Lee A. Expression of pRb, p53, p16 and cyclin D1 and their clinical implications in urothelial carcinoma. J Korean Med Sci. 2010; 25:1449–1455.

13. Xylinas E, Cha EK, Sun M, Rink M, Trinh QD, Novara G, Green DA, Pycha A, Fradet Y, Daneshmand S, et al. Risk stratification of pT1-3N0 patients after radical cystectomy for adjuvant chemotherapy counselling. Br J Cancer. 2012; 107:1826–1832.

14. Stein JP, Grossfeld GD, Freeman JA, Esrig D, Ginsberg DA, Cote RJ, Skinner EC, Boyd SD, Lieskovsky G, Skinner DG. Orthotopic lower urinary tract reconstruction in women using the Kock ileal neobladder: updated experience in 34 patients. J Urol. 1997; 158:400–405.

15. Elmajian DA, Stein JP, Esrig D, Freeman JA, Skinner EC, Boyd SD, Lieskovsky G, Skinner DG. The Kock ileal neobladder: updated experience in 295 male patients. J Urol. 1996; 156:920–925.

16. Montironi R, Lopez-Beltran A. The 2004 WHO classification of bladder tumors: a summary and commentary. Int J Surg Pathol. 2005; 13:143–153.

17. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17:1471–1474.

18. Novara G, Svatek RS, Karakiewicz PI, Skinner E, Ficarra V, Fradet Y, Lotan Y, Isbarn H, Capitanio U, Bastian PJ, et al. Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients. J Urol. 2010; 183:2165–2170.

19. Shariat SF, Svatek RS, Tilki D, Skinner E, Karakiewicz PI, Capitanio U, Bastian PJ, Volkmer BG, Kassouf W, Novara G, et al. International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. BJU Int. 2010; 105:1402–1412.

20. Von der Maase H, Hansen SW, Roberts JT, Dogliotti L, Oliver T, Moore MJ, Bodrogi I, Albers P, Knuth A, Lippert CM, et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol. 2000; 18:3068–3077.

21. Prout GR, Marshall VF. The prognosis with untreated bladder tumors. Cancer. 1956; 9:551–558.

22. Stenzl A, Cowan NC, De Santis M, Jakse G, Kuczyk MA, Merseburger AS, Ribal MJ, Sherif A, Witjes JA. The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol. 2009; 55:815–825.

23. Jeong IG, You D, Kim J, Kim SC, Hong JH, Ahn H, Kim CS. Factors associated with non-orthotopic urinary diversion after radical cystectomy. World J Urol. 2012; 30:815–820.

24. Hautmann RE, Paiss T. Does the option of the ileal neobladder stimulate patient and physician decision toward earlier cystectomy? J Urol. 1998; 159:1845–1850.

25. Power NE, Kassouf W, Bell D, Aprikian AG, Fradet Y, Lacombe L, Chin J, Izawa J, Estey E, Fairey A, et al. Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort. Can Urol Assoc J. 2012; 6:E217–E223.

26. Stein JP, Cai J, Groshen S, Skinner DG. Risk factors for patients with pelvic lymph node metastases following radical cystectomy with en bloc pelvic lymphadenectomy: concept of lymph node density. J Urol. 2003; 170:35–41.

27. Kassouf W, Agarwal PK, Herr HW, Munsell MF, Spiess PE, Brown GA, Pisters L, Grossman HB, Dinney CP, Kamat AM. Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: analysis of pooled data from MDACC and MSKCC. J Clin Oncol. 2008; 26:121–126.