Radical cystectomy for the treatment of T1 bladder cancer: the Canadian Bladder Cancer Network experience

Background: Radical cystectomy may provide optimal survivaloutcomes in the management of clinical T1 bladder cancer. Wepresent our data from a large, multi-institutional, contemporaryCanadian series of patients who underwent radical cystectomy forclinical T1 bladder cancer in a single-payer health care system.Methods: We collected a pooled database of 2287 patients whounderwent radical cystectomy between 1993 and 2008 in 8 differentcentres across Canada; 306 of these patients had clinical T1bladder cancer. Survival data were analyzed using Kaplan-Meiermethod and Cox regression analysis.Results: The median age of patients was 67 years with a mean follow-up time of 35 months. The 5-year overall, disease-specific anddisease-free survival was 71%, 77% and 59%, respectively. The10-year overall and disease-specific survival were 60% and 67%,respectively. Pathologic stage distribution was p0: 32 (11%), pT1:78 (26%), pT2: 55 (19%), pT3: 60 (20%), pT4: 27 (9%), pTa: 16(5%), pTis: 28 (10%), pN0: 215 (74%) and pN1-3: 78 (26%). Only12% of patients were given adjuvant chemotherapy. On multivariateanalysis, only margin status and pN stage were independentlyassociated with overall, disease-specific and disease-free survival.Interpretation: These results indicate that clinical T1 bladder cancermay be significantly understaged. Identifying factors associatedwith understaged and/or disease destined to progress (despite anyprior intravesical or repeat transurethral therapies prior to radicalcystectomy) will be critical to improve survival outcomes withoutover-treating clinical T1 disease that can be successfully managedwith bladder preservation strategies.Contexte : La cystectomie radicale peut donner des résultats optimauxen lien avec la survie dans la prise en charge d’un cancerde la vessie de stade clinique T1. Nous présentons ici les donnéesprovenant d’une récente étude multicentrique de grande envergureportant sur des patients canadiens ayant subi une cystectomie radicalepour le traitement d’un cancer de la vessie de stade cliniqueT1 dans un système de santé à payeur unique.Méthodologie : Nous avons cumulé les données provenant de2 287 patients ayant subi une cystectomie radicale entre 1993et 2008 dans 8 centres différents au Canada; 306 de ces patientsprésentaient un cancer de la vessie de stade clinique T1. Les donnéesliées à la survie ont été analysées à l’aide de la méthode deKaplan-Meier et du modèle de régression de Cox.Résultats : L’âge médian des patients était