RESULTS OF RADICAL CYSTECTOMY FOR TRANSITIONAL-CELL CARCINOMA OF THE BLADDER AND THE EFFECT OF CHEMOTHERAPY

Background. Radical cystectomy continues to be one of the primary moda lities of treatment for locally advanced bladder cancer. However, long -term survival after cystectomy has improved only marginally in the la st decade, and still, nearly half of the patients die from the disease within 5 years. Adjuvant treatments such as radiation therapy and che motherapy have been used, but a clear advantage has not been demonstra ted. Methods. The authors reviewed 130 patients who underwent radical cystectomy by the same surgeon as treatment for transitional cell carc inoma of the bladder. Morbidity, postoperative mortality, overall surv ival time, and accuracy of clinical staging as well as the effect of p erioperative chemotherapy were evaluated. Results. The overall actuari al survival rate at 2, 5, and 10 years was 80%, 53%, and 45%, respecti vely. The survival rate based on T-classification at 5 years was 82%, 65%, and 28% for less than pT2, pT2, and greater than pT2, respectivel y. Regional lymph node status had a significant effect on survival. Th e 5-year survival rate for all patients with negative nodes was 65%, w hereas patients with positive nodes had a 18% 5-year survival rate. Th e overall clinical staging error was 61.5%, with 41.5% of the cancers understaged. Of the patients with cTis, 60% were found to be of greate r extent than pT1 tumors. No apparent survival advantage was noted for those patients who received perioperative chemotherapy when compared with patients who were followed conservatively or received chemotherap y upon relapse. These results, however, are not conclusive because thi s was an observation study and the number of patients was limited. Con clusions. Only a modest improvement in survival time after radical cys tectomy has been observed in the last decade, despite the use of adjuv ant treatments such as radiation and chemotherapy. The pathologic (pT) classification is the most accurate prognostic indicator. Clinical er rors in classification are common and impair the evaluation of neoadju vant treatments. A high incidence of invasive tumors of greater extent than pT1 was found among patients with clinical cTis; this supports a n aggressive approach when these patients do not respond promptly to i ntravesical chemotherapy. Prospective randomized studies are needed to evaluate objectively the benefit of perioperative adjuvant treatment in locally advanced transitional cell carcinoma of the bladder.