Muscle-invasive transitional cell carcinoma of the urinary bladder: A population-based study of patterns of care and prognostic factors

Purpose: Population-based cancer registries can permit the study of the sur vivorship of all patients with a particular diagnosis regardless of pattern s of referral and practice within a specific geographic distribution. The p urpose of this study is to describe the patterns of care, outcome, and prog nostic factors for bladder cancer in the northern region of the province of Alberta, Canada, between 1984 and 1993. Methods and Materials: Between 1984 and 1993, 184 patients from northern Al berta were identified from the Alberta Cancer Registry as having undergone curative treatment for biopsy-proven muscle-invasive transitional cell carc inoma of the bladder. Data were obtained, by retrospective chart review, re garding the staging, pathology, treatment, and outcome of patients treated in the northern Alberta cities of Edmonton, Grande Prairie, and Red Deer, r egardless of the responsible treating institution. The prognostic significa nce of patient-, tumor-, and treatment-related variables were tested using univariate and multivariate analysis using the Cox proportional-hazard mode l. Results: As the primary treatment modality, 74 patients (40%) received radi cal radiotherapy (RT) without surgery; surgery was used alone in 81 patient s (44%), and was combined with preoperative or postoperative radiotherapy i n 29 patients (16%). Seventy-three (40%) patients also received concurrent, neoadjuvant, or adjuvant chemotherapy. The Kaplan-Meier estimate of median survival was 2.2 years, and the 5-year overall survival was 30%. Univariat e analysis demonstrated the prognostic significance of T classification (p < 0.001), lymph node involvement (p < 0.001), complete response to RT (p = 0.001), hydronephrosis (p = 0.017), and vascular/lymphatic involvement (p = 0.035). Multivariate analysis revealed the following to have a significant association with survival: T classification (p = 0.001), lymph node involv ement (p = 0.004), complete response to RT (p = 0.054), hydronephrosis (p = 0.019), and use of chemotherapy in the treatment regimen (p = 0.025). Conclusion: The strongest prognostic factors in this study were tumor relat ed, and no significant differences in survival were detected between patien ts treated with primary surgery vs. organ-preservation approaches. A surviv al advantage associated with the incorporation of chemotherapy into the man agement schema was detected on multivariate, but not univariate, analysis. Stratification of patients based on tumor characteristics is imperative in clinical trials for invasive bladder cancer. Novel treatment approaches are required to improve survival further in patients with apparently localized disease. (C) 2001 Elsevier Science Inc.