Survival Outcomes in Bladder Cancer: An Ambispective Study of Patients Undergoing Radical Cystectomy

TL;DR

This study examines survival outcomes in bladder cancer patients who underwent radical cystectomy, finding that achieving a complete response and quitting smoking improve survival.

Contribution

The study provides survival data and identifies predictors of disease-free and overall survival in bladder cancer patients after radical cystectomy.

Findings

Median disease-free survival was 145 months and median overall survival was 118 months.

Pathological complete response was significantly associated with improved disease-free survival.

Smoking was a significant predictor of worse overall survival.

Abstract

Introduction

Radical cystectomy (RC) with pelvic lymph node dissection and urinary diversion is the preferred treatment for non-metastatic muscle invasive bladder cancer (MIBC) and for some high-risk non-muscle invasive bladder cancer (NMIBC), in patients fit for major surgery.

Primary objective

The primary objective of this study is to estimate the overall survival (OS) of patients with MIBC who have undergone RC.

Secondary objective

The secondary objectives are to estimate the disease-free survival (DFS) of patients with MIBC following RC and to determine factors that influence OS and DFS in this population.

Methodology

This was an ambispective study of patients who underwent RC for carcinoma of the urinary bladder between 1st January 2010 and 30th April 2022. Clinicopathological data were obtained from the patients’ clinical records.

Results

The study included a total of 106 patients, with a mean age of 59.35 years. Of these, 55.88% had received neoadjuvant chemotherapy (NACT), and 13 patients (11.7%) underwent salvage cystectomy. Only five patients received intravesical chemotherapy instillation following transurethral resection of bladder tumor (TURBT). RC was performed via laparotomy in 82 patients, while 24 patients underwent a laparoscopic approach. The mean hospital stay was five days. Ninety-eight patients had Clavien-Dindo grade II morbidity. There were no intra-hospital or 30-day mortalities. The histopathologic report showed that 21 patients had achieved pathological complete response (PCR). A total of 96 patients were kept on follow-up, of whom 32 patients had recurrence. Median DFS was 145 months, and median OS was 118 months. PCR was found to be significantly associated with improved DFS. Smoking was found to be a significant predictor of OS on multivariate analysis.

Conclusions

Although NACT did not reach statistical significance as an independent predictor of survival, it contributed to the achievement of PCR, which was predictive of DFS and OS. Hence, NACT should be pursued wherever feasible. Further, this study shows the importance of smoking cessation, as current or recent smoking was found to have a negative impact on survival among patients with bladder cancer.

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