OBJECTIVE: To evaluate survival in cystectomy patients who presented with non-muscle-invasive urothelial carcinoma and progressed to muscle invasion during surveillance.
Our secondary objective was to evaluate the association between pre-cystectomy clinical factors and survival.
PATIENTS AND METHODS: Nine-hundred and eighty-one consecutive Mayo Clinic cystectomy patients without a history of radiation or systemic chemotherapy were reviewed. Of these, 190 had cystectomy after they progressed from non-muscle invasive disease to muscle invasion (progressed to ≥pT2). These patients were compared to 310 patients who had cystectomy prior to muscle invasion (≤ pT1), and 481 patients who had muscle invasion at initial presentation (presented with ≥pT2). Survival estimates were generated using the Kaplan-Meier method and compared using the log-rank test while adjusted analyses were performed using Cox proportional hazard regression models.
RESULTS: Patients who progressed to muscle invasion on surveillance had higher risk of death compared to patients who initially presented with muscle invasion (overall survival HR 1.3; 95%CI 1.0, 1.5). Estimated 5-year cancer-specific survival was 85.4% for patients presenting with ≤ pT1, 52.9% for patients who progressed to ≥pT2, and 62.4% for patients who presented with ≥pT2 (p< 0.001). The corresponding 5-year overall survival rates were 70.0%, 42.1%, and 49.5% (p< 0.001). Of the patients who initially presented with non-muscle-invasive disease, progression to muscle invasion was associated with increased risk of cancer-specific death (adjusted HR 2.38; 95% CI 1.6, 3.5). Lack of information about patients who presented without muscle invasion and never received cystectomy is the major limitation of this study.
CONCLUSION: Despite close surveillance, many patients who progress to muscle invasion will die from bladder cancer. Patients who progress to muscle invasion on surveillance seem to have particularly aggressive disease and may benefit from multimodal treatments.
Breau R, Karnes R, Farmer S, Thapa P, Cagiannos I, Morash C, Frank I. Are you the author?
Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa, ON.
Reference: BJU Int. 2013 Aug 12. Epub ahead of print.