Effect of Stage Migration on Bladder Cancer: A Slow but Steady Improvement in Long-Term Survival Rates After Radical Cystectomy in Previous 25 Years

We evaluated the effect of the year of surgery on the clinical, pathologic, and oncologic outcomes of patients with bladder cancer (BCa) treated with radical cystectomy (RC) at a single institution.

The present study included 1253 consecutive patients with BCa treated with RC and extended pelvic lymphadenectomy at a single institution from January 1990 to December 2014. Analysis of variance and χ(2) trend tests were used to report the clinical and pathologic characteristics of the cohort over time. Multivariable Cox regression analysis was used to test the relationship between the year of surgery and recurrence, cancer-specific mortality (CSM) and overall mortality (OM).

Considering the clinical characteristics, patient age (P = .1) and gender (P = .2) remained steady during the study period. In contrast, the body mass index (P < .005) increased. Also, of the pathologic features, carcinoma in situ detection (P < .001) showed an increasing rate, and pathologic stage T3-T4 (P = .005) showed a decreasing trend. The number of lymph nodes removed increased during the study period (P < .001), resulting in an increased number of positive nodes (P < .001). However, the rate of lymph node invasion (P = .1) remained stable in the overall population. Multivariable Cox regression analyses revealed the year of surgery as a predictor of recurrence (hazard ratio [HR], 0.97), CSM (HR, 0.97), and OM (HR, 0.98), with a slight, but constant, reduction in all survival outcomes (P < .04 for all).

Changes were recorded considering the patient and tumor characteristics across the previous 25 years. These variations directly reflect the differences in long-term survival expectations we recorded.

Clinical genitourinary cancer. 2016 Aug 08 [Epub ahead of print]

Marco Moschini, Stefano Luzzago, Walter Cazzaniga, Vito Cucchiara, Marco Bandini, Rocco Damiano, Francesco Soria, Tobias Klatte, Shahrokh F Shariat, Andrea Salonia, Francesco Montorsi, Alberto Briganti, Renzo Colombo, Andrea Gallina

Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: ., Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria.