The effect of the time interval between diagnosis of muscle-invasive bladder cancer and radical cystectomy on staging and survival: A Netherlands Cancer Registry analysis

• Published in: Urologic oncology 2016-04, Vol.34 (4), p.166.e1-166.e6
• Main Authors: Bruins, Harman Maxim, M.D., Ph.D, Aben, Katja K.H., Ph.D, Arends, Tom J., M.D, van der Heijden, Antoine G., M.D., Ph.D, Witjes, Alfred J., M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Aged; Cystectomy - methods; Cystectomy - mortality; Female; Humans; Male; Middle Aged; Muscle-invasive bladder cancer; Neoadjuvant Therapy; Neoplasm Staging; Netherlands - epidemiology; Overall survival; Radical cystectomy; Staging; Survival Rate; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2015.11.006

Abstract Introduction Data from single-center series suggest that a delay in time to radical cystectomy (RC) more than 3 months after diagnosis of muscle-invasive bladder cancer (MIBC) is associated with pathological upstaging and decreased survival. However, limited data is available from population-based studies. In this study, the effect of delayed RC was assessed in a nationwide cohort. Materials and methods Patients who underwent RC between 2006 and 2010 with primary clinical T2-T4N0M0 urothelial bladder cancer were selected using the Netherlands Cancer Registry database. Data from the Netherlands Cancer Registry was supplemented with data from the Nationwide Network and Registry of Histo- and Cytopathology database in case of incomplete information. The cohort was divided in patients who underwent RC ≤3 months (group I) vs. patients who underwent RC >3 months (group II). Median time from MIBC diagnosis to RC, variables associated with delayed RC >3 and the effect of delayed RC on staging and overall survival (OS) were evaluated in patients who underwent neoadjuvant therapy and patients who did not. Results A total of 1,782 patients were included. Median follow-up time was 5.1 years for living patients and 1.3 years for deceased patients. Median time from MIBC diagnosis to RC was 50 days (interquartile range: 27 days) and 93% of patients underwent RC≤3 months. Patients older than 75 years (odds ratio [OR] = 0.50; 95% CI: 0.32–0.77), referred for RC (OR = 0.41; 95% CI: 0.26–0.69), and treated in a university hospital (OR = 0.34; 95% CI: 0.21–0.56) were less likely to undergo RC≤3 months. Pathologic upstaging rate (43.9% vs. 42.1%) and node-positive disease rate (20.2% vs. 21.7%) did not differ for group I and II. Delayed RC>3 months was not associated with decreased OS adjusting for confounding variables (hazard ratio = 1.16; 95% CI: 0.91–1.48; P = 0.25). Median time from MIBC diagnosis to RC in patients that received neoadjuvant therapy ( n = 105) was 133 days (interquartile range: 62 days). Adjusting for confounding variables, delayed RC>3 months was not associated with OS (hazard ratio = 0.90; 95% CI: 0.45–1.82). Conclusions The vast majority of patient underwent RC within 3 months after diagnosis of MIBC, as recommended in the European Association of Urology MIBC guideline. Delayed RC for more than 3 months had no adverse effect on staging and survival.