ABSTRACT

To evaluate variable prognostic factors which might affect disease-specific survival in patients who have undergone radical cystectomy and pelvic lymphadenectomy for bladder carcinoma.

We retrospectively reviewed 241 consecutive patients with invasive bladder carcinoma between 1990 and 2008, all had radical cystectomy. The clinical and pathological data and clinical outcome were evaluated. The Chi-square test was used to determine the significance of the relations-hip between the clinical and pathological findings. While disease-specific survival and the association between patient`s parameters and survival were analyzed using Kaplan-Meier method and long-rank test respectively.

Considering the type of urinary diversion, 97 patients had ileal conduit; 58 patients had ort-hotopic bladder using ileal segment; and orthotopic mainz pouch was applied to 43 patients. While ureterocutaneostomy and ureterosigmoidostomy were the choice in 22 and 21 patients respectively. The mean age of the patients at receipt of the surgical procedure was 59.8 years (range from 29 to 83 years) and the mean follow-up interval was 34 months (median follow up: 22, SD: 36.66; range from 1 to 175) for patients alive at last follow-up. According to the pathological stage, the 5-year survival rate was found to be 72.9%, %77.6%, 48.0%, 25.4% and 28.8% for pT0, pT1, pT2, pT3 and pT4 respectively. (Figure 1; log-rank test, p<0.001). Moreover, it is found that 6.5%, 11.5%, 16.7%, 49.1% and 48.6% were the local recurrence and/or metastasis rate for pT0, pT1, pT2, pT3 and pT4 respectively (p<0.001). It is seen that lymph node involvement obviously rise with the advance in pathological stage. In another word, the rate of having nodal metastasis was significantly higher in patients with pT3 or more (pT3: 26.3%, pT4: 20%) than in those with pT2 or less (pT0 and pT1: 0%, pT2: 6.1%), ( p<0.001). On univariate analysis, patient`s age, presence of tumor-related hydronephrosis, lymph node status, pathological stage and grade were significant predictors of disease-specific survival.

In this study, it is clearly shown that good results could be obtained if radical cystec-tomy is the treatment of choice for patients with early diagnosed invasive bladder carcinoma.

Keywords: bladder cancer, radical cystectomy, prognosis