DOES A STAGE PT0 CYSTECTOMY SPECIMEN CONFER A SURVIVAL ADVANTAGE IN PATIENTS WITH MINIMALLY INVASIVE BLADDER-CANCER

Controversy exists regarding the clinical significance of a pathologic al stage T0 (pT0) specimen found at cystectomy or after repeat transur ethral resection for transitional cell carcinoma of the bladder. Many investigators cite this subpopulation of patients as a reason to consi der more conservative management, based on the premise that the patien t may have benefited from the original transurethral resection. Howeve r, we questioned whether outcome would be improved in stage pT0 cancer patients or whether outcome in stage pT0 cases would parallel that no ted when the original stage was equivalent to the final pathological s tage. To test this hypothesis, we examined the survival advantage occa sioned by a stage pT0 finding in 66 of 433 patients who underwent radi cal cystectomy for transitional cell carcinoma of the bladder. Of the 433 patients studied 54 had clinical stage Tis or Ta, 166 clinical sta ge T1 and 213 clinical stage T2 disease. Within each of the 3 clinical groups (clinical stage Tis/Ta, clinical stage T1 and clinical stage T 2) Kaplan-Meier survival projections were generated comparing patients with stage pT0 disease to those whose pathological stage was identica l to the original clinical stage. Among the 54 clinical stage Tis/Ta c ancer patients 11 with stage pT0 and 24 with stage pTis/pTa had surviv al projections of 90% at 5 years. Of 166 patients with clinical stage T1 disease 32 with stage pT0 and 78 with stage pT1 tumor had survival projections of 75% at 5 years. Among 213 patients with clinical stage T2 cancer 23 with stage pT0 and 71 with stage pT2 disease had survival projections of 68% at 5 years. The data suggest that a stage pT0 cyst ectomy specimen does not confer a survival advantage over that noted f rom the initiating population in which the final pathological stage an d initial clinical stage are equivalent. A patient with a stage pT0 sp ecimen functions, by survival analysis, in a manner similar to one wit h the stated clinical stage.