An Interval Longer than 12 Weeks Between the Diagnosis of Muscle Invasion and Cystectomy is Associated with Worse Outcome in Bladder Carcinoma

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jan 2003An Interval Longer than 12 Weeks Between the Diagnosis of Muscle Invasion and Cystectomy is Associated with Worse Outcome in Bladder Carcinoma RICARDO F. SÁNCHEZ-ORTIZ, WILLIAM C. HUANG, ROSEMARIE MICK, KEITH N. VAN ARSDALEN, ALAN J. WEIN, and S. BRUCE MALKOWICZ RICARDO F. SÁNCHEZ-ORTIZRICARDO F. SÁNCHEZ-ORTIZ , WILLIAM C. HUANGWILLIAM C. HUANG , ROSEMARIE MICKROSEMARIE MICK , KEITH N. VAN ARSDALENKEITH N. VAN ARSDALEN , ALAN J. WEINALAN J. WEIN , and S. BRUCE MALKOWICZS. BRUCE MALKOWICZ View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64047-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The standard of care for muscle invasive transitional cell carcinoma of the bladder is radical cystectomy. Definitive therapy may often be delayed for various reasons. We assessed whether pathological stage and survival correlated with the length of time between diagnosis of muscle invasion and cystectomy. Materials and Methods: The records of 290 consecutive patients who underwent radical cystectomy between February 1987 and July 2000 were reviewed. Of 265 (91.4%) cystectomies performed for transitional cell carcinoma data were available for 247 (85.2%) and 189 (65.2%) patients were identified who underwent surgery for muscle invasive disease (T2 or greater). The interval between diagnosis of muscle invasion and cystectomy was calculated for each patient. Patients were divided into groups based on time to surgery as group 1—less than 4 weeks, 2—4 to 6 weeks, 3—7 to 9 weeks, 4—10 to 12 weeks, 5—13 to 16 weeks, and 6—greater than 16 weeks. Exploratory univariate and multivariate analyses were performed to test the association of time lag with clinical features and postoperative survival. Results: Mean patient age was 66 years (range 37 to 84) and overall 3-year Kaplan-Meier estimated survival was 59.1% ± 4% (median followup 36 months). For all patients mean interval from diagnosis to cystectomy was 7.9 weeks (range 1 to 40). Extravesical disease (P3a or greater) or positive nodes were identified in 84% (16 of 19) of patients when the delay was longer than 12 weeks, compared with 48.2% (82 of 170) in those with a time lag of 12 weeks or less (p < 0.01). Similarly 3-year estimated survival was lower (34.9% ± 13.5%) for patients with a surgery delay longer than 12 weeks compared to those with a shorter interval 62.1% ± 4.5% (hazards ratio 2.51, 95% CI 1.30–4.83, p = 0.006). When adjusted for nodal status, and clinical and pathological stages the interval was still statistically significant (adjusted hazards ratio 1.93, 95% CI 0.99–3.76, p = 0.05). 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Volume 169Issue 1January 2003Page: 110-115 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordscarcinomaneoplasm invasivenesssurvivalbladdertime factorsMetricsAuthor Information RICARDO F. SÁNCHEZ-ORTIZ More articles by this author WILLIAM C. HUANG More articles by this author ROSEMARIE MICK More articles by this author KEITH N. VAN ARSDALEN More articles by this author ALAN J. WEIN Financial interest and/or other relationship with Allergan, Bayer, C. R. Bard, Conticare, Eli Lilly, Merck, Pfizer, Pharmacia Corp., Situs, TAP Pharma, Waston Labs, Yamanouchi and Zeneca Pharma. More articles by this author S. BRUCE MALKOWICZ Financial interest and/or other relationship with Astra Zeneca, Merck and Novartis. Requests for reprints: Division of Urology, University ofPennsylvania, 3400 Spruce St., Philadelphia, Pennsylvania 19104. More articles by this author Expand All Advertisement PDF downloadLoading ...