Multicenter evaluation of the prognostic value of pT0 stage after radical cystectomy due to urothelial carcinoma of the bladder

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Only little and often contradictory data exist pertaining to the frequency and prognosis of patients with stage pT0 after radical cystectomy (RC). Furthermore there is discussion about the role of a radical transurethral resection of the urinary bladder (TURB) for complete tumour eradication. Within a RC population with clinical tumour stages cTa-cT2, cN0, cM0 and no neoadjuvant chemotherapy or radiotherapy, ≈6% had pathological stage pT0 with a 5-year cancer-specific survival (CSS) rate of 87%. Clinical tumour stage (advantage for non-invasive stages) and TURB time frame (advantage for more recent surgery) were independent predictors for stage pT0. A radical TURB is, assumedly, not the cause of this improved survival rate, but rather it is that individual tumour characteristics allow for complete tumour eradication through the TURB procedure. Concluding, a TURB with R0 resection is, as such, only a sign of a better tumour prognosis. OBJECTIVE • To evaluate the characteristics and long-term outcome of patients with pT0 stage after radical cystectomy (RC) for urothelial carcinoma of the urinary bladder (UCB). PATIENTS AND METHODS • Clinical and pathological records of 2403 patients treated with RC for UCB were collected in a multi-institutional database. • The patients met the following criteria: clinical tumour stage cTa-cT2, cN0, cM0, no neoadjuvant chemotherapy or radiotherapy. • Overall (OS) and cancer-specific survival rates (CSS) were calculated for the various clinical tumour stages in relation to their corresponding pathological tumour stage in the RC sample. • Further to this, a multivariable prediction model was developed based onthe available clinical data to estimate the probability of tumour stage pT0. RESULTS • The mean follow-up was 53 months and 132 patients (5.5%) were stage pT0. • Patients withstage cT2-pT0 had a 5-year CSS of 87% vs 69% for cT2-pT2 (P= 0.012) and 57% for cT2-pT+ (P < 0.001). • In a multivariable Cox-model, stage pT0 led to a significant reduction of cancer-specific mortality (hazard ratio0.27; 95% confidence interval 0.12-0.61). • A logistical regression model identified clinical tumour stage (advantage for non-invasive stages) and transurethral resection of the urinary bladder (TURB) time frame (advantage for more recent surgery) as independent predictors for stage pT0. CONCLUSIONS • In muscle-invasive clinical tumour stages, patients with pathological tumour stage pT0 form a subgroup showing a significantly better CSS. • A radical TURB is, assumedly, not causative of this improved survival rate, but rather it is that individual tumour characteristics allow for complete tumour eradication through the TURB procedure. • A TURB with R0 resection is, as such, only a sign of a better tumour prognosis.