Unaltered oncological outcomes of radical cystectomy with extended lymphadenectomy over three decades

Abstract

Objective To evaluate oncological outcome trends over the last three decades in patients after radical cystectomy (RC) and extended pelvic lymph node (LN) dissection. Patients and Methods Retrospective analysis of the University of Southern California (USC) RC cohort of patients (1488 patients) operated with intent to cure from 1980 to 2005 for biopsy confirmed muscle‐invasive urothelial bladder cancer. To focus on outcomes of unexpected (cN0M0) LN‐positive patients, the USC subset was extended with unexpected LN‐positive patients from the University of Berne (UB) (combined subgroup 521 patients). Patients were grouped and compared according to decade of surgery (1980–1989/1990–1999/≥2000). Survival probabilities were calculated with Kaplan–Meier plots, log‐rank tests compared outcomes according to decade of surgery, followed by multivariable verification. Results The 10‐year recurrence‐free survival was 78–80% in patients with organ‐confined, LN‐negative disease, 53–60% in patients with extravesical, yet LN‐negative disease and ≈30% in LN‐positive patients. Although the number of patients receiving systemic chemotherapy increased, no survival improvement was noted in either the entire USC cohort, or in the combined LN‐positive USC‐UB cohort. In contrast, patient age at surgery increased progressively, suggesting a relative survival benefit. Conclusions Radical surgery remains the mainstay of therapy for muscle‐invasive bladder cancer. Yet, our study reveals predictable outcomes but no survival improvement in patients undergoing RC over the last three decades. Any future survival improvements are likely to result from more effective systemic treatments and/or earlier detection of the disease.

Population-based assessment of racial/ethnic differences in utilization of radical cystectomy for patients diagnosed with bladder cancer

“…5, 6 Although the pathologic TNM classification is a durable prognostic variable, considerable heterogeneity in outcomes within stage groups has been reported. 5, 6 Taking into account the unaltered survival outcomes in bladder cancer treatment over the last three decades, 7 an aggressive approach to optimizing treatment is needed.…”

Recurrence Patterns After Open and Robot-assisted Radical Cystectomy for Bladder Cancer

“…Open radical cystectomy (ORC) is the mainstay of therapy for patients with muscle-invasive and high-risk non–muscle-invasive bladder cancer (BCa) [1]. Following successful adoption of minimally invasive techniques in kidney and prostate surgery, the last few years have seen growing interest in robot-assisted radical cystectomy (RARC).…”

FGFR3 Expression in Primary Invasive Bladder Cancers and Matched Lymph Node Metastases

“…Metastatic disease is the most common cause of death in bladder cancer but currently used chemotherapy regimes have limited efficacy and overall survival is low (10 year-survival for patients with lymph node positive disease ~ 30%). 12 Thus, there is an urgent need for improved approaches to therapy for these patients. FGFR inhibitors may be relevant agents to apply in combination with platinum-based chemotherapy.…”