[Survival in patients treated with radical cystectomy for bladder carcinoma]

To analyze survival among cystectomized bladder cancer patients.

A retrospective cohort study comprising data from 166 bladder cancer patients subjected to cystectomy between 1976 and 1998. Patient survival was considered the dependent variable, while sociodemographic data, renal function parameters, the existence of hydronephrosis, anaesthetic risk according to ASA status, the type of urinary diversion involved, the histopathological characteristics and postoperative complications were regarded as the independent variables. Survival was analyzed by the Kaplan-Meier method, comparing survival curves with the Mantel-Haennszel test, and developing a Cox proportional risk model.

The mean survival was 81 months (median = 20 months); 82% of the patients died of causes related to the neoplastic process or surgical complications. The probability of survival 60 months after surgery was 35.2%--the figure being higher among patients aged < or = 65 years (p = 0.026), without prior hydronephrosis (p = 0.023), or with normal creatinine levels (p = 0.048). The principal influencing factor was tumor histological stage: for lesions in stage < or = pT2 survival at 60 months was 67.8%, versus 29.1% in stage pT3 and only 6% in pT4. In the presence of lymph node involvement, only 6.1% of the patients were still alive after 5 years.

The local infiltration stage and pelvic node involvement are the two most decisive factors for patients prognosis. Hydronephrosis and increased creatinine levels before cystectomy are the two non-hystopatological parameters associated to a poorer prognosis.