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. 2007 Sep;52(3):769-74.
doi: 10.1016/j.eururo.2007.03.086. Epub 2007 Apr 10.

P0 stage at radical cystectomy for bladder cancer is associated with improved outcome independent of traditional clinical risk factors

Wassim Kassouf  1 , Philippe E Spiess, Gordon A Brown, Mark F Munsell, H Barton Grossman, Arlene Siefker-Radtke, Colin P N Dinney, Ashish M Kamat
Affiliations

P0 stage at radical cystectomy for bladder cancer is associated with improved outcome independent of traditional clinical risk factors

Wassim Kassouf et al. Eur Urol. 2007 Sep.

Abstract

Objectives: Final pathologic specimen free of detectable disease (P0) is not uncommon in patients undergoing cystectomy for bladder cancer, especially in the era of neoadjuvant chemotherapy. To improve our understanding of its significance in a contemporary series, we performed an outcomes analysis of this cohort of patients.

Methods: Over the last 15 yr, 1104 patients with bladder cancer underwent radical cystectomy at our institution. Of these, 120 (11%) were pT0N0M0 (P0) in the surgical specimen and form the basis of this report. Survival data were estimated by method of Kaplan and Meier, with Cox proportional hazards regression model used to evaluate associations between survival and variables studied.

Results: Clinical stages were cT1, 21 patients; cT2, 65; cT3b, 20; cT4a, 11; and cT4b, 3. The 5-yr estimates of overall (OS), disease-specific (DSS), and recurrence-free survival (RFS) rates were 84%, 88%, and 84%, respectively. With mean follow-up of 43 mo, 11 patients developed recurrences, 9 of whom died of disease. Median time to recurrence was 7.7 mo (range: 2.2-45 mo). On multivariate analysis, presence of lymphovascular invasion and concomitant carcinoma in situ on the transurethral resection of the bladder tumor specimen were the only significant prognostic factors associated with shorter OS (p = 0.04) and RFS (p = 0.049), respectively. Notably, patients who received preoperative chemotherapy (n = 77) had 5-yr survival rates similar to those of patients who did not.

Conclusion: Although patients who are P0 at cystectomy have a good prognosis, not all can be considered cured. The favorable prognosis conferred by a P0 state appears to be independent of whether this is achieved by neoadjuvant chemotherapy or by thorough transurethral resection before cystectomy.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier estimate of overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) for all patients who were P0 at cystectomy.
Fig. 2
Fig. 2
Kaplan-Meier estimate of overall survival (OS) stratified by the use of preoperative chemotherapy (p = 0.32).
Fig. 3
Fig. 3
Kaplan-Meier estimate of overall survival (OS) stratified by the presence of lymphovascular invasion (p = 0.08, multivariate p = 0.04).
Fig. 4
Fig. 4
Kaplan-Meier estimate of recurrence-free survival (RFS) stratified by the presence of concomitant carcinoma in situ (p= 0.049).
Fig. 5
Fig. 5
Kaplan-Meier estimate of overall survival (OS) stratified by clinical stage (p = 0.693).
See this image and copyright information in PMC

Comment in

References

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