Impact of stage migration on bladder cancer: A slow but steady improvement in the long term survival rates after radical cystectomy in the last 25 years

Risultato della ricerca: Posterpeer review


INTRODUCTION & OBJECTIVES: Bladder cancer (BCa) is a heterogeneous disease with up to 25% of incidental diagnoses reported to be found muscle invasive at firstepisode. Numerous markers and an increased awareness have been recorded in the recent years. We sought to evaluate if those considerat ions may determine a change inBCa clinical presentation at radical cystectomy (RC) over years in a single high volume tert iary referral center.MATERIAL & METHODS: The study relied on 2,003 consecutive BCa pat ients treated with RC and extended pelvic lymphadenectomy (PLND) at a single inst itutionbetween January 1990 and December 2014. Pat ients were st ratified into tertiles according to the year of surgery (1990-2000 vs. 2001-2009 vs. 2010-2014). Anova andchi-square trend tests were used to report the clinical and pathological characterist ics of the cohort over t ime. Mult ivariable Cox regression analysis was used to test therelationship between year of surgery and recurrence, cancer specific mortality (CSM) and overall mortality (OM).RESULTS: When considering clinical characterist ics, patient age (66.7 vs. 66.5 vs. 67.6 years, p=0.1) and gender (81.9% vs. 82.7% vs. 85.4% male, p=0.2) resultedsteady over the three tertiles. Conversely body mass index (BMI) (24.7 vs. 25.6 vs. 26.0, p<0.005) increased over the studied period. Considering pathological features, CISdetect ion (8.8% vs. 19.8% vs. 34.4%, p<0.001) showed an increasing rate, while pathological T3-4 stage (64.1% vs. 48.6% vs. 51.6%, p=0.005) expressed a decreasingt rend. The number of nodes removed increased during tertiles (16.8 vs. 22.7% vs. 26.78, p<0.001) resulting in an increased number of posit ive nodes over years (5.1 vs.7.1 vs. 7.8, p<0.001). However, lymph node invasion (34.6% vs. 29.8% vs. 33.7%, p>0.1) remain stable across years in the overall populat ion. At multivariable Coxregression analyses, year of surgery represent a predictor of recurrence (HR: 0.97), CSM (HR: 0.97) and OM (HR: 0.98), with a slight but constant reduction in all survivaloutcomes (all p<0.04).CONCLUSIONS: A significant increase of BMI over years has been recorded in patients affected by BCa treated with RC. Considering pathological characteristics, higher ratesof CIS but lower rates of pathological advanced disease were recorded in recent years, with a reduct ion in the prevalence of pT3/pT4 disease. These variat ions direct lyreflect the differences in terms of long term survival expectances recorded in our series across the last 25 years.
Lingua originaleEnglish
Numero di pagine1
Stato di pubblicazionePublished - 2016


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