Comparing long‐term outcomes of primary and progressive carcinoma invading bladder muscle after radical cystectomy

<jats:sec><jats:title>Objective</jats:title><jats:p>To assess the impact of primary or progressive status on recurrence‐free survival (<jats:styled-content style="fixed-case">RFS</jats:styled-content>), cancer‐specific mortality (<jats:styled-content style="fixed-case">CSM</jats:styled-content>) and overall mortality (<jats:styled-content style="fixed-case">OM</jats:styled-content>) after radical cystectomy (<jats:styled-content style="fixed-case">RC</jats:styled-content>) for muscle‐ invasive bladder cancer (<jats:styled-content style="fixed-case">MIBC</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p>A total of 768 consecutive patients underwent <jats:styled-content style="fixed-case">RC</jats:styled-content> as treatment for <jats:styled-content style="fixed-case">MIBC</jats:styled-content> at our institution between 2000 and 2012. Primary <jats:styled-content style="fixed-case">MIBC</jats:styled-content> was defined as no previous history of bladder cancer and progressive was defined as recorded previous treated non‐<jats:styled-content style="fixed-case">MIBC</jats:styled-content> (<jats:styled-content style="fixed-case">NMIBC</jats:styled-content>) that had progressed to <jats:styled-content style="fixed-case">MIBC</jats:styled-content>. The median follow‐up was 85 (60–109) months. Univariate and multivariate Cox regression models were used to compare <jats:styled-content style="fixed-case">RFS</jats:styled-content>,<jats:styled-content style="fixed-case"> CSM</jats:styled-content> and <jats:styled-content style="fixed-case">OM</jats:styled-content> between these two cohorts.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In all, 475 (61.8%) patients had primary and 293 (38.2%) patients had progressive <jats:styled-content style="fixed-case">MIBC</jats:styled-content>. There were no differences between the two groups in terms of demographics, pathological and peri‐operative complications (all <jats:italic>P</jats:italic> > 0.1). The 10‐year <jats:styled-content style="fixed-case">RFS</jats:styled-content>,<jats:styled-content style="fixed-case"> CSM</jats:styled-content> and <jats:styled-content style="fixed-case">OM</jats:styled-content> rates for primary vs progressive status were 43 vs 36% (<jats:italic>P</jats:italic> = 0.01), 43 vs 37% (<jats:italic>P</jats:italic> = 0.01), and 35 vs 28% (<jats:italic>P</jats:italic> = 0.03), respectively. On multivariable Cox regression analyses, progressive status remained significantly associated with a higher rate of recurrence (hazard ratio [<jats:styled-content style="fixed-case">HR</jats:styled-content>] 1.47, 95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>] 1.12–1.79; <jats:italic>P</jats:italic> = 0.03), <jats:styled-content style="fixed-case">CSM</jats:styled-content> (<jats:styled-content style="fixed-case">HR</jats:styled-content> 1.42, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.07–1.89; <jats:italic>P</jats:italic> = 0.01) and <jats:styled-content style="fixed-case">OM</jats:styled-content> (<jats:styled-content style="fixed-case">HR</jats:styled-content>1.42, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.13–1.65; <jats:italic>P</jats:italic> = 0.02).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Among patients treated with <jats:styled-content style="fixed-case">RC</jats:styled-content> for <jats:styled-content style="fixed-case">MIBC</jats:styled-content>, progressive status was associated with a higher <jats:styled-content style="fixed-case">CSM</jats:styled-content>,<jats:styled-content style="fixed-case"> OM</jats:styled-content> and recurrence rate after <jats:styled-content style="fixed-case">RC</jats:styled-content>. The present study thus provides an impetus to improve risk sub‐stratification when bladder cancer is still at the <jats:styled-content style="fixed-case">NMIBC</jats:styled-content> stage, be it through new biomarkers or improved imaging, as a subset of patients with <jats:styled-content style="fixed-case">NMIBC</jats:styled-content> are likely to benefit from early <jats:styled-content style="fixed-case">RC</jats:styled-content>.</jats:p></jats:sec>