Outcomes for a large series of radical cystectomies for bladder cancer

We present the characteristics and outcomes of a large Chinese series of patients treated with radical cystectomy and pelvic lymphadenectomy for invasive cancer of the bladder. Our aim is to determine the significant independent prognostic factors that determine this outcome.

The records of 356 patients with invasive bladder cancer, operated at three Chinese medical institutes between 1995 and 2004, were reviewed. Of the 356 patients, 324 (91.0%) were TCC, 24 (6.7%) were adenocarcinoma, eight (2.3%) were squamous carcinoma. The incidence of pelvic lymph node involvement was 22.8%. The mean (SD, range) follow-up of the 356 patients was 54.89 (31.66, 3-137) months. Multivariate analysis was used to assess the clinical and pathological variables affecting disease-free survival (DFS).

The 1-, 2- and 5-year DFS rates were 87%, 75% and 48%, respectively. In multivariate analysis, tumor configuration (RR=1.62, p=0.012), multiplicity (RR=1.41, p=0.036), histological subtype (RR=2.17, p<0.001), tumor stage (RR=2.50, p<0.001), tumor grade (RR=2.40, p<0.001), node status (RR=2.51, p<0.001), neoadjuvant chemotherapy (RR=0.46, p=0.016) had independent significance for survival on multivariate analysis.

The results of this series show that radical cystectomy and pelvic lymphadenectomy provide durable local control and DFS in patients with invasive bladder cancer. Multivariates affect the prognosis after radical cystectomy for invasive bladder cancer. The treatment of invasive bladder cancer in China is still in need of improvement and normalization.