Radical Cystectomy for Bladder Cancer Today—A Homogeneous Series Without Neoadjuvant Therapy

• Published in: Journal of clinical oncology Vol. 21; no. 4; pp. 690 - 696
• Main Authors: MADERSBACHER, Stephan, HOCHREITER, Werner, BURKHARD, Fiona, THALMANN, George N, DANUSER, Hansjörg, MARKWALDER, Regula, STUDER, Urs E
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 15.02.2003; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Cystectomy; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Human; Relapse; Urinary system disease; Prognosis; Lymph node; Malignant lymphadenopathy; Malignant hemopathy; Malignant tumor; Urinary tract disease; Transitional cell carcinoma; Metastasis; Lymphadenectomy; Cystectomy; Pelvic ganglion; Treatment; Urinary bladder; Surgery; Bladder disease
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2003.05.101

To investigate the effect of pelvic lymph node dissection and radical cystectomy for transitional cell cancer of the bladder on recurrence-free and overall survival, pelvic recurrences, and metastatic patterns in a homogeneous group. A consecutive series of patients undergoing pelvic lymphadenectomy and radical cystectomy between 1985 and 2000 was analyzed. All patients were staged N0, M0 preoperatively, and no patient received neoadjuvant radio/chemotherapy. Pathologic characteristics based on the 1997 tumor-node-metastasis system, recurrence-free/overall survival, and metastatic patterns were determined. Five hundred seven patients (age 66 +/- 12 years) with a mean follow-up time of 45 months (range, 0.1 to 176 months) were analyzed. Five-year recurrence-free and overall survival were, respectively, 73% and 62% for patients with organ-confined, lymph node-negative tumors (n = 217; < or = pT2, pN0) and 56% and 49% for non-organ-confined, lymph node-negative tumors (n = 166; > pT2, pN0). Positive lymph nodes were found in 124 (24%) patients who had a 5-year recurrence-free (33%) or overall (26%) survival. Isolated local recurrences were observed in 3% of patients with organ-confined tumors (< or = pT2, pN0), 11% with non-organ-confined tumors (> pT2, pN0), and 13% with positive lymph nodes (any pT, pN+). Distant metastases developed in 25% of patients with organ-confined tumors, 37% with non-organ-confined tumors, and 51% with positive lymph nodes. Despite negative preoperative staging, pelvic lymphadenectomy and cystectomy for bladder cancer reveal a high percentage of unsuspected nodal metastases (24%) that have a 25% chance for long-term survival. This procedure also ensures a low pelvic recurrence rate even in lymph node-positive patients, and patients with locally advanced cancer have a 56% probability of 5-year recurrence-free survival.