To determine the difference in survival after cystectomy between patients presenting with primary muscle infiltrating bladder cancer and patients with progression to muscle infiltration after treatment for initial non−muscle−invasive bladder cancer (NMIBC).

We retrospectively analyzed the files of 188 patients who underwent cystectomy for transitional cell carcinoma between 1987 and 2005. Two groups were defined: patients presenting with muscle−invasive tumours and those progressing to muscle invasion after initial treatment. This second group was further divided into low−intermediate and high risk according to the EAU grouping for NMIBC.

The 5−year disease specific survival (95% confidence intervals) for all patients was 50%(42−59%); 49%(40−60%) in the primary muscle infiltrating group and 52%(37−74%) in the progressive group (p = ns). The 5−year disease specific survival in the progressive group according to EAU risk groups was 75%(58−97%) for the initially diagnosed low−intermediate risk tumours and 35%(17−71%) for the initially diagnosed high−risk tumours (p = 0.015). The percentage of patients with non−locally confined tumours (pT3/4−N0//any pT−N+) was 31%//45% and 24%//46% in the primary muscle infiltrating and progressive group, respectively.

Despite close observation of patients treated for non−muscle−invasive bladder cancer, the survival of patients who progress to muscle invasion is not better than survival of patients presenting with primary muscle infiltrating cancer. Patients with high−risk non−invasive tumours (EAU risk−categories) who progress to muscle−invasive disease have a worse prognosis compared to patients with low or intermediate risk tumours. Copyright © 2009 Elsevier Ltd. All rights reserved.

PMID: 20097512 [PubMed − as supplied by publisher] Source: National Library of Medicine.