RADICAL CYSTECTOMY FOR CARCINOMA OF THE BLADDER - CRITICAL-EVALUATIONOF THE RESULTS IN 1,026 CASES

Purpose: We performed a critical analysis of the different prognostic factors affecting survival among patients with carcinoma of the bladde r for whom cystectomy was indicated. The different patient and tumor c haracteristics were correlated to survival data by a univariate as wel l as multivariate analysis. Materials and Methods: Between 1969 and 19 90, 764 men and 262 women, average age plus or minus standard deviatio n 43 +/- 8 years, with invasive carcinoma of the bladder were eligible for 1-stage radical cystectomy and urinary diversion. Patients were f ollowed regularly and examined signs for and location of treatment fai lure. Followup ranged from 0 to 24.2 years, with a median plus or minu s standard deviation of 4.05 +/- 4.16 years. Results: Postoperative mo rtality was 4%. Most of the patients presented with advanced stage (gr eater than P3) disease. Squamous tumors accounted for 59% of cases, tr ansitional carcinoma 22% and adenocarcinoma 11%. Bilharzial eggs were seen in 85% of the specimens, Regional lymph nodes were involved in 18 .3% of the cases, The 5-year survival rate was 48%. The survival estim ate was correlated to patient and tumor characteristics by univariate and multivariate analyses. Only tumor stage and grade, and lymph node status had a significant impact on survival. Conclusions: Contemporary cystectomy with continent diversion for muscle invasive disease provi des minimal morbidity, offers good locoregional disease control and re sults in acceptable quality of life, The presence of positive regional lymph nodes is not a contraindication to this therapy.