Predicting the survival of bladder carcinoma patients treated with radicalcystectomy

BACKGROUND. Clinical outcomes vary for patients treated with radical cystec tomy. The authors sought to identify factors associated with the survival o f patients treated with radical cystectomy for urothelial carcinoma of the urinary bladder. METHODS. The authors studied 218 patients treated with radical cystectomy f or urothelial carcinoma between 1980 to 1984. Patient ages ranged from 41 t o 78 years (mean, 64 years). Using the 1997 TNM system, T classifications w ere Ta (17 patients), T1 (44), T2 (71), T3a (42), T3b (14), T4a (28), and T 4b (2). Thirty-two patients had lymph node metastasis at the time of surger y. Histologic grade was determined according to the newly proposed World He alth Organization and International Society of Urological Pathology grading system; tumor was low grade in 43 patients and high grade in 175. The male -to-female ratio was 4.9 to 1. The mean follow-up of patients still alive w as 13.1 years (median, 13.8 years; range, 30 days to 18 years). Cox proport ional hazards models were used to determine the impact of numerous clinical and pathologic findings on survival. RESULTS. Ten-year local recurrence free, distant metastasis free, cancer sp ecific, and all-cause survival were 71%, 73%, 67%, and 41%, respectively. I n univariate analysis, cancer size, T classification, and lymph node status were associated with distant metastasis free, cancer specific, and all-cau se survival. Histologic grade and surgical margin status were significantly associated with worse cancer specific and all-cause survival, but not with distant metastasis free survival. In multivariate analysis, cancer size, m argin status, T classification, and lymph node status were identified as si gnificantly associated with cancer specific survival after adjustment for a ge and gender. CONCLUSIONS. Long term survival is achieved in a significant number of pati ents treated with radical cystectomy. In this study, patients with organ-co nfined (less than or equal to pT2) and small size (less than or equal to 3 cm) cancer had favorable 10-year distant metastasis free (93%) and cancer s pecific survival (88%) after cystectomy. Tumor size, margin status, extrave sical involvement, and lymph node metastasis are important pathologic facto rs and should be considered as stratification variables in identifying pati ents for whom adjuvant chemotherapy should be evaluated in clinical trials. Cancer 2000;88:2326-32. (C) 2000 American Cancer Society.