Radical cystectomy in the treatment of invasive bladder cancer: Long-term results in 1,054 patients

Purpose: To evaluate our long-term experience with patients treated uniform ly with radical cystectomy and pelvic lymph node dissection for invasive bl adder cancer and to describe the association of the primary bladder tumor s tage and regional lymph node status with clinical outcomes. Patients and Methods: All patients undergoing radical cystectomy with bilat eral pelvic iliac lymphadenectomy, with the intent to cure, for transitiona l-cell carcinoma of the bladder between July 1971 and December 1997, with o r without adjuvant radiation or chemotherapy, were evaluated. The clinical course, pathologic characteristics, and long-term clinical outcomes were ev aluated in this group of patients. Results: A total of 1,054 patients (843 men [80%] and 211 women) with a med ian age of 66 years (range, 22 to 93 years) were uniformly treated. Median follow-up was 10.2 years (range, 0 to 28 years). There were 27 (2.5%) perio perative deaths, with a total of 292 (28%) early complications. Overall rec urrence-free survival at 5 and 10 years for the entire cohort was 68% and 6 6%, respectively. The 5- and 10-year recurrence-free survival for patients with organ-confined, lymph node-negative tumors was 92% and 86% for P0 dise ase, 91% and 89% for Pis, 79% and 74% for Pa, and 83% and 78% for P1 tumors , respectively. Patients with muscle invasive (P2 and P3a], lymph node-nega tive tumors had 89% and 87% and 78% and 76% 5- and 10-year recurrence-free survival, respectively. Patients with nonorgan-confined (P3b, P4), lymph no de-negative tumors demonstrated a significantly higher probability of recur rence compared with those with organ-confined bladder cancers (P < .001). T he 5- and 10-year recurrence-free survival for P3b tumors was 62% and 61%, and for P4 tumors was 50% and 45%, respectively. A total of 246 patients (2 4%) had lymph node tumor involvement. The 5 and 10-year recurrence-free sur vival for these patients was 35%, and 34%, respectively, which was signific antly lower than for patients without lymph node involvement (P < .001). Pa tients could also be stratified by the number of lymph nodes involved and b y the extent of the primary bladder tumor (p stage). Patients with fewer th an five positive lymph nodes, and whose p stage was organ-confined had sign ificantly improved survival rates. Bladder cancer recurred in 311 patients (30%). The median time to recurrence among those patients in whom the cance r recurred was 12 months (range, 0.04 to 11.1 years). In 234 patients (22%) there was a distant recurrence, and in 77 patients (7%) there was a local (pelvic) recurrence. Conclusion: These data from a large group of patients support the aggressiv e surgical management of invasive bladder cancer. Excellent long term survi val can be achieved with a low incidence of pelvic recurrence. (C) 2001 by American Society of Clinical Oncology.