Onset of treatment failure after radical cystectomy for bladder carcinoma

ABSTRACT

To correlate the patients and tumor characteristics to the onset of treatment failure after radical cystectomy, to see if there are risk factors associated with early failure within the first 2 years versus later recurrence. Between 1980 and 1995, 1450 patients were subjected to radical cystectomy and bilateral pelvic lymph node dissection for biopsy-proven invasive bladder carcinoma. 1116 were males and 334 were females with a mean age of 48.76 +/- 9.3 years. Mean follow up period was 5.9 +/- 3.5 years [range 1-17]. At last follow up, 885 [59%] patients were alive and free of disease and 460 [31.7%] were living with, or died from disease. Patients who died from unknown causes [8.6%] and those who died postoperatively [0.7%] were excluded to ensure cancer-specific treatment failure in this study. Among patients who had cancer-specific treatment failure [460], 86% failed within the first two years while the remaining 14% failed later. The relationship between the onset of treatment failure [2 years vs. > 2 years] and patients and tumor characteristics was assessed using Chi-Square test. Factors with significant association were further analyzed in a multivariate analysis. There was a significant relationship between the tumor histology and the onset of tumor recurrence as 30% of recurrence with aden-ocarcinoma occurred after the first 2 years while 12% and 13% of squamous cell carcinoma and transitional cell carcinoma failed during the same period respectively [P = 0.01]. There was a significant relationship between the stage of the tumor and onset of treatment failure as 93.8% of recurrence with non-organ confined tumor [P3 or more] occurred within first 2 years while 84% of organ confined tumor [P2 or less] failed during the same period [P = 0.01]. A highly significant correlation was also found with nodal involvement as 93% of relapse with positive nodes occurred within the first 2 years while 82% of negative nodes failed during the same period [P = 0.001]. The tumor grade, ploidy and lymphovascular invasion had no significant correlation with the onset of the treatment failure [P > 0.05]. The three significant factors by univariate analysis sustained their significance independently in multivariate analysis. Lymph node involvement and high stage tumors were associated significantly with early treatment failure. Although most of histological cell types relapsed within the first 2 years, adenocarcinoma has the tendency to relapse later. These results may help in planning the time, dose and type of adjuvant therapy