[Differences in survival of patients with bladder cancer depending on depth of muscle infiltration]

To study the survival of patients with bladder cancer and infiltration into the muscle who undergo radical cystectomy, documenting any survival difference based on the depth of muscle infiltration (pT2a vs. pT2b).

109 patients with infiltration into the muscle (T2) in the TUR were treated with radical cystectomy between 1986 and 1996; 39 patients were excluded due to infra-staging and 2 died in the immediate postoperative: 68 patients were eligible for the study. Median follow-up was 51 months. At the time of analysis 44 were alive (2 with tumoral disease and one with a second non-urological tumour), 21 had died (4 for causes other than vesical tumour) and 3 patients were considered lost to follow-up at 3, 31 and 111 months. Survival analysis was performed using the Kaplan-Meier method, and the variables were compared with the log-rank test.

The 3- and 5-year overall survival of our series was 76% and 62%, while cancer specific survival was 80% and 70% respectively. Cancer specific survival at 5 years by stages was: pT0-83%, pT1-80%, pT2a-66% and pT2b-60% (p = 0.52). The cystectomy specimen (pT0) showed no residual tumour in 15 (22%) patients, and 5-year cancer specific survival in this group was 83% vs. 66% in patients with residual cancer (p = 0.24).

Patients with pT2a and pT2b bladder cancer showed no differences in survival and we believe they should be all included in the same prognostic group (pT2). pT0 patients are a subgroup of patients with significant survival rates in which radical cystectomy should be considered as overtreatment, and a more conservative protocol should be preferred.