Radical cystectomy in patients with pathological non-muscle invasive bladder cancer / 北京大学学报(医学版)

ABSTRACT

Objective:Carcinoma of bladder is the most common malignancy in the urinary system in China.Most patients with this disease had non-muscle invasive bladder cancer (NMIBC)at the time of diagnosis.Radical cystectomy was indicated for patients with high risk or refractory NMIBC.We aimed to investigate the overall survival and disease-specific survival and related influence factors in patients un-dergoing radical cystectomy for pathological non-muscle invasive bladder cancer.Methods:From Jan. 2006 to Dec.2012,a total of 164 patients with pathological non-muscle invasive bladder cancer under-went radical cystectomy in Peking University First Hospital.Clinical data were retrospectively collected. Incidence of lymph node metastasis and disease recurrence were calculated.The risk factors of disease re-currence were analyzed.Kaplan-Meier plots were used to estimate the overall survival and cancer-specific survival.Multivariate Cox regression analysis was used to evaluate the prognostic factors for survival.Re-sultsOf all the patients included,159 had T1 disease,and 5 had CIS only.The median follow-up dura-tion was 46.5 months (range7 -99 months).Fourteen patients were lost during the follow-up.Lymph node metastasis was noted in 6 patients (3.7%),4 patients had N1 disease,one patient had N2 di-sease,and one patient had N3 disease.Disease recurrence occurred in 16 patients (9.8%).The most common recurrence sites were the liver,bones,and lungs.The 5-year overall survival and disease-spe-cific survival for all the patients were 85% and 91%,respectively.The patients who underwent pelvic lymph node dissection showed a better prognosis in terms of disease-specific survival than those without (P =0.012).Patients with recurrence harbored a significant poorer survival (P <0.001).According to univariate Cox regression analysis,whether lymph node dissection was performed was an independent risk factor of disease recurrence (P =0.050,OR =2.695,95%CI 0.999 -7.271).In COX regression mo-del,age (P =0.008,OR =1.071,95%CI 1.018 -1.126)and whether lymph node dissection was performed (P =0.011,OR =3.385,95%CI 1.329 -8.621)were related to disease-specific survival. Conclusion:Patients with pathological non-muscle invasive bladder cancer underwent early radical cys-tectomy have a favorable prognosis,and bilateral pelvic lymph node dissection is essential for this proce-dure as it gains a survival benefit for the patients.