Oncologic outcomes and survival in pT0 tumors after radical cystectomy in patients without neoadjuvant chemotherapy: results from a large multicentre collaborative study.
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Rouprêt Morgan, Drouin Sarah J, Larré Stéphane, Neuzillet Yann, Botto Henry, Hitier Maryam, Rigaud Jerome, Crew Jeremy, Xylinas Evanguelos, Salomon Laurent, Cornu Jean-Nicolas, Iborra François, Champetier Denis, Rozet François, Flamand Vincent, Bastide Cyrille, Cormier Luc, Durand Xavier, Lunardi Pierre, Rischmann Pascal, Nouhaud François-Xavier, Ferlicot Sophie, Patard Jean-Jacques, Floch Aurélie Paule, Irani Jacques, Peyronnet Benoit, Bensalah Karim, Poissonnier Laura, Grès Pascale, Droupy Stéphane, Casenave Julien, Wallerand Hervé, Soulié Michel, Pfister Christian, Bladder Cancer Committee of the French National Association of Urology (“CC-AFU Vessie”)
Аннотация
METHODS: A multi-institutional, retrospective database was analyzed with data from 4758 radical cystectomy (RC) patients who underwent RC without neoadjuvant chemotherapy and who were diagnosed with pT0 on the basis of the pathologic specimen. Survival curves were estimated. A multivariate Cox model was used to evaluate the association between prognosis factors and disease recurrence or survival.
RESULTS: Overall, 258 patients (5.4%) were included in the study. The median age was 64 years. At last resection, 171 tumors were invasive (at least pT2), and 87 were not. Median follow-up was 51 months. At multivariate analysis, initial location of the tumor and absence of lymphadenectomy were associated with tumor recurrence (P = 0.03 and P = 0.005, respectively) and specific mortality (P = 0.005 and 0.001, respectively). The main limitation of the study is its retrospective design, which is due to the rarity of this situation. Cancer-specific and recurrence-free survival rates were 89 and 85%, respectively, at 5 years and 82 and 80%, respectively, at 10 years.
CONCLUSIONS: Despite acceptable oncological outcomes, patients with a pT0 tumor at the time of RC are still at risk of recurrence and progression and should not be considered to be entirely cured. In this population, stringent follow-up according to current recommendations should be effective.