Раковая наука и терапия

Oncologic Outcomes after Radical Cystectomy: Comparison between Primary and Progressive Muscle Invasive Bladder Cancer

Abstract

Khalid Lmezguidi, Abdelatif Janane, Fouad Hajji, Omar Jendouzi, Mohamed Alami, Ahmed Ameur, Mohamed Abbar

Background: Between primary and progressive muscle-invasive bladder cancer, in the current literature, data regarding the prognostic difference and survival between this two entities are controversial. Objectives: To assess differences in survival between the primary and progressive MIBC and to determine main prognostic factors in muscle-invasive bladder tumors (MIBT).

Material and methods: All patients who were underwent radical cystectomy for MIBC in our institution between 1990 and 2014 were retrospectively evaluated using an institutional database. A total of 308 patients had met inclusion criteria, 218 (70,77%) (Group 1) with primary MIBC and 90 (29.22%) (Group 2) with progressive MIBC. The main variables studied were: age, sex, initial tumor stage of TURs in group 2, pathologic stage (T/N), type of urinary diversion and extent of LND. Survival rate was investigated with Kaplan-Meier method and a multivariate analysis using the Cox regression analysis was performed to evaluate potential prognostic factors.

Results: In Group 2, the median time of progression to invasive cancer was 32 months. 2, 3 and 5-year cancer specific survival rate after surgery was 77%, 63% and 51% in Group 1 and 59%, 49% and 32% in group 2, respectively (p < 0.05). Analyzing pN stage, overall 2,3 and 5-year survival rate were 75%, 62%, and 53% in group 1 and 61%, 49%, and 37% in group 2 respectively for pN0 (P <0.05). On multivariate analysis, lympho-vascular invasion and pT stage of the primary tumor remained significant independent prognostic factors for cancer-specific survival.

Conclusions: Our study has shown that Progressive MIBC have a worse prognosis than Primary MIBC. Lympho-vascular invasion and Positive nodes in RC specimens seems to be an independent factor that decreases survival in patients with MIBC.