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Lee, Cho, and Hong: The Difference in the Prognosis and Characteristics between the Progressive and Primary Muscle-invasive Bladder Cancer Treated with Radical Cystectomy
Original Article
Korean Journal of Urology

Korean Journal of Urology 2007; 48(11): 1109-1115.

Published online: 30 November 2007

DOI: https://doi.org/10.4111/kju.2007.48.11.1109

The Difference in the Prognosis and Characteristics between the Progressive and Primary Muscle-invasive Bladder Cancer Treated with Radical Cystectomy

Young Hoon Lee, Kang Su Cho, Sung Joon Hong

Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author (sjhong346@yumc.yonsei.ac.kr)

Received 9 July 2007       Accepted 1 October 2007

Copyright © 2007 The Korean Urological Association

Abstract

Purpose

We investigated the difference of the prognosis between progressive and primary muscle-invasive bladder cancer treated with radical cystectomy.

Materials and Methods

We retrospectively reviewed the medical records of invasive bladder cancer patients who were treated with radical cystectomy between 1986 and 2004. The patients who underwent progression from superficial cancer to muscle invasive cancer within 3 months, and those who underwent bladder preservation or neoadjuvant therapy were excluded. Fifty progressive muscle-invasive cancer patients (the progressive group) and 173 primary muscle-invasive cancer patients (the primary group) were eligible for this study. Univariate and multivariate analysis were performed to identify the associations between the clinicopathological features and survival, and the characteristics between the two groups were compared with using the chi-square test.

Results

Among the total patients, 102 patients (45.7%) died of cancer. On univariate analysis, age, gender, tumor size, multiplicity, tumor grade and carcinoma in situ did not influence survival (p>0.05). However, the T stage (p<0.001), lymphovascular invasion (p=0.004), and lymph node involvement (p<0.001) had a significant influence on disease-specific survival. Notably, the 5-year disease-specific survival rate for the primary group (61.1%) was significantly higher than that for the progressive group (36.4%) (p<0.001). On multivariate analysis, T stage (p<0.001), lymphovascular invasion (p=0.036), and the progressive disease (p=0.001) were independent prognostic factors. Comparing the characteristics between the two groups, multiplicity was more frequent in the primary group (p=0.029) and nodal involvement was more frequent in the progressive group (p=0.035).

Conclusions

Progressive muscle-invasive bladder cancer has a poorer prognosis than primary invasive cancer. This poor prognosis is thought to be associated with increased lymph node involvement and micrometastasis in the progressive group.

Keywords: Urinary bladder neoplasm, Cystectomy, Prognosis, Carcinoma, transitional cell

Figures and Tables

Fig. 1
Overall disease-specific survival rate.
kju-48-1109-g001
Fig. 2
Kaplan-Meier curves for 5 year survival comparing the primary and progressive muscle-invasive bladder cancer groups.
kju-48-1109-g002
Table 1
Patient characteristics
kju-48-1109-i001

MIBC: muscle-invasive bladder cancer

Table 2
Univariate analysisfor disease specific survival rate of patients with muscle-invasive bladder cancer
kju-48-1109-i002

*p-value by Kaplan-Meier estimation and log-rank test. DSS: disease-specific survival, MIBC: muscle-invasive bladder cancer

Table 3
Multivariate Cox proportional hazard model for muscle-invasive cancer
kju-48-1109-i003

MIBC: muscle-invasive bladder cancer

Table 4
Comparisons between the primary and progressive muscle-invasive bladder cancer groups
kju-48-1109-i004

*p-value by chi-square test. MIBC: muscle-invasive bladder cancer

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