Cystectomy for bladder cancer: A contemporary series

Purpose: To validate the current TNM staging system, we analyzed our contem porary experience with 300 cystectomies. Materials and Methods: The pathological material and medical records of 300 patients treated with cystectomy were reviewed, and the new TNM classifica tion was adopted. Results: The median followup of patients with no evidence of disease was 65 months, and overall survival rate was 45% with a median survival of 50 mon ths. In a Cox regression analysis only patient age, pT stage and neoadjuvan t chemotherapy were significant factors for survival. The disease specific survival was 67% with a median survival of 94 months. In a multiple proport ional hazards analysis only pT stage and previous chemotherapy were signifi cant factors of disease specific survival. A significant difference was see n in the overall and disease specific survival between patients with organ confined and nonorgan confined tumors. We did not observe a difference in t he survival rate among patients with pT4a to pT3 tumors. Significant differ ences were not seen in survival rates between sexes or among patients of di fferent age groups. Transitional cell carcinoma was the predominant histolo gical type, and no significant difference was found in patient outcome amon g the different histological subtypes. Conclusions: Bladder cancer can be categorized into organ confined and nono rgan confined tumors. This dichotomous grouping is better suited for evalua ting adjuvant clinical trials. The pT stage of the bladder and prostate sho uld be prospectively analyzed together to better define the clinical implic ations of prostatic involvement. In our opinion the histological subtypes d o not affect outcome.