Artikel
An observation of the cancer specific survival of patients after radical cystectomy in urothelial cell carcinoma of the bladder over the last decade: A single center study
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Autoren
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J.-F. Jokisch
- Ludwig-Maximilians-Universität München, München, Germany
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T. Grimm
- Ludwig-Maximilians-Universität München, München, Germany
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A. Buchner
- Ludwig-Maximilians-Universität München, München, Germany
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B. Schneevoigt
- Ludwig-Maximilians-Universität München, München, Germany
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C. Stief
- Ludwig-Maximilians-Universität München, München, Germany
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A. Karl
- Ludwig-Maximilians-Universität München, München, Germany
| Veröffentlicht: | 20. April 2016 |
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Gliederung
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Introduction: For the last three decades the radical cystectomy (RC) with bilateral lymph node dissection remains the gold standard of surgical therapy in muscle-invasive (MIBC) and BCG-refractory non-muscle-invasive bladder cancer (NMIBC). There is only limited data concerning potentially changes in the cancer specific survival (CSS) of urothelial cell carcinoma of the bladder (UCC).
Objective: As a consequence this retrospective and single-centred study focused on a potential alteration of CSS in UCC of the bladder after RC over a period of the last 11 years.
Methods: Medical records of patients undergoing RC in UCC of the bladder were analysed, after exclusion of patients receiving neo- or adjuvant systemic chemotherapy a total number of 500 was selected. Then 2 chronographic subdivisions of the period from 2004-2009 versus 2010-2015 were implemented.
Results: Univariate analysis shows a significant better CSS in the cohort from 2010-2015 (CSS of 2004-9=67% vs. CSS of 2010-15=77%). Multivariate analysis of TNM-classification and date of surgery of both chronographic cohorts showed that date of surgery has no independent prognostic factor (2004-9 vs. 2010-5 HR= 0.7; p=0.108). Tumour stage and in sano resection of tumour remain the significant prognostic parameters for CSS in UC: pTy3/pT3-4 HR=4.7;p< 0.001 and R0/R1 HR=2.2;p=0.002. In the period from 2004-9 40% UC accounting to pT3-4 compared to 36% in the period observing 2010-5 (p=0.355).
Conclusion: A univariate analysis of both collectives indicates a significant increase of CSS in patients treated within the last 5 years. Nevertheless the multivariate analysis of both patient cohorts suggests no significant differences in CSS for the tumour stages, respectively. Although not significant, the absolute data of patients outline a tendency of lower tumour stages leading to RC in UC of the bladder. This could be explained in an early detection of urothelial neoplasms of the bladder, through improvement and availability of improved detection tools.
