Korean J Urol.  2007 Nov;48(11):1109-1115. 10.4111/kju.2007.48.11.1109.

The Difference in the Prognosis and Characteristics between the Progressive and Primary Muscle-invasive Bladder Cancer Treated with Radical Cystectomy

• Lee YH
• Cho KS
• Hong SJ

• KMID: 1997085
• DOI: http://doi.org/10.4111/kju.2007.48.11.1109

Abstract

PURPOSE: We investigated the difference of the prognosis between progressive and primary muscle-invasive bladder cancer treated with radical cystectomy.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of invasive bladder cancer patients who were treated with radical cystectomy between 1986 and 2004. The patients who underwent progression from superficial cancer to muscle invasive cancer within 3 months, and those who underwent bladder preservation or neoadjuvant therapy were excluded. Fifty progressive muscle-invasive cancer patients (the progressive group) and 173 primary muscle-invasive cancer patients (the primary group) were eligible for this study. Univariate and multivariate analysis were performed to identify the associations between the clinicopathological features and survival, and the characteristics between the two groups were compared with using the chi-square test.
RESULTS
Among the total patients, 102 patients(45.7%) died of cancer. On univariate analysis, age, gender, tumor size, multiplicity, tumor grade and carcinoma in situ did not influence survival(p>0.05). However, the T stage(p<0.001), lymphovascular invasion(p=0.004), and lymph node involvement(p<0.001) had a significant influence on disease-specific survival. Notably, the 5-year disease-specific survival rate for the primary group(61.1%) was significantly higher than that for the progressive group (36.4%)(p<0.001). On multivariate analysis, T stage(p<0.001), lymphovascular invasion(p=0.036), and the progressive disease(p=0.001) were independent prognostic factors. Comparing the characteristics between the two groups, multiplicity was more frequent in the primary group(p=0.029) and nodal involvement was more frequent in the progressive group(p=0.035).
CONCLUSIONS
Progressive muscle-invasive bladder cancer has a poorer prognosis than primary invasive cancer. This poor prognosis is thought to be associated with increased lymph node involvement and micrometastasis in the progressive group.

Keyword

Urinary bladder neoplasm; Cystectomy; Prognosis; Carcinoma, transitional cell

MeSH Terms

Carcinoma in Situ
Carcinoma, Transitional Cell
Cystectomy*
Humans
Lymph Nodes
Medical Records
Multivariate Analysis
Neoadjuvant Therapy
Neoplasm Micrometastasis
Prognosis*
Retrospective Studies
Survival Rate
Urinary Bladder Neoplasms*
Urinary Bladder*

Figure

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  Fig. 1 Overall disease-specific survival rate.

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  Fig. 2 Kaplan-Meier curves for 5 year survival comparing the primary and progressive muscle-invasive bladder cancer groups.

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