A BLADDER-CANCER MULTIINSTITUTIONAL EXPERIENCE WITH TOTAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER-CANCER

Background. The role of total cystectomy was to be assessed in the cur ative treatment of muscle-invasive bladder cancer. Methods. Two hundre d and fifty-three patients with T2-T4a transitional cell carcinoma of the urinary bladder were referred to precystectomy radiation therapy ( 46 Gy, 66 patients; 20 Gy, 187 patients). These patients represented a pproximately 20% of all patients developing muscle-invasive bladder ca ncer in Southern Norway from 1980-1990. The clinical T categorization was generally based on palpability and extent of the palpable bladder tumor assessed by the referring urologist. Twenty-six patients (10%) d id not have total cystectomy, most often due to peroperatively demonst rated locoregional inoperability. Two or three cycles of cisplatin-bas ed combination chemotherapy were given to 68 patients. Results. For th e 227 patients who underwent cystectomy, the cancer-specific 5-year su rvival rate was 58% (T2 [104 patients], 63%; greater than or equal to T3 [123 patients], 54%) (P = 0.022). The comparable figure for patient s with histologically proven regional lymph node metastases was 22%. T he 97 stage-reduced cases (less than or equal to pT1) survived signifi cantly longer than the 130 patients without stage reduction (74% versu s 46%) (P < 0.0001). Neoadjuvant chemotherapy was correlated with a mo re favorable survival in patients with greater than or equal to T3 tum ors but did not seem to influence survival of patients with T2 bladder cancer. Conclusions. In a multicenter setting, prognostically relevan t T categorization of operable muscle-infiltrating bladder cancer can be based on the palpability of the primary tumor. Approximately 50% of favorably selected patients with operable T2-T4 bladder cancer surviv ed for at least 5 years independent of whether the operation was done at a large uro-oncologic unit or a smaller urologic section. In this r etrospective review, chemotherapy seemed to improve the survival in pa tients with deeply infiltrating (greater than or equal to T3) bladder cancer but appeared to represent an overtreatment in patients with T2 tumors.