Radical Cystectomy for Progressive Versus de Novo Muscle-Invasive Bladder Cancer
Posted: Thursday, March 25, 2021
Patients first diagnosed with non–muscle-invasive bladder cancer that then progressed to muscle-invasive bladder cancer may have worse survival outcomes than those with de novo muscle-invasive bladder cancer, according to research conducted by Antoine G. van der Heijden, MD, PhD, of Radboud University Medical Center, Nijmegen, The Netherlands, and colleagues. These findings, which were published in Cancer Treatment and Research Communications, require further study to distinguish specific subgroups who may benefit from early cystectomy.
“Progressive muscle-invasive bladder cancer is associated with poorer survival than de novo muscle-invasive bladder cancer. Because most patients with progressive muscle-invasive bladder cancer had a history of high-risk non–muscle-invasive bladder cancer, considering radical cystectomy is most important in the highest risk non–muscle-invasive bladder cancer,” the study authors wrote.
The study focused on 313 patients diagnosed with de novo muscle-invasive bladder cancer and 118 with progressive muscle-invasive bladder cancer. Researchers observed a significantly better survival rate for patients with de novo disease, with 5- and 10-year overall survival rates of 49% and 39%, respectively. Conversely, patients with progressive disease had 5- and 10-year overall survival rates of 37% and 20%, respectively. Further analysis showed that concomitant carcinoma in situ and positive surgical margins may be more common in patients with progressive muscle-invasive bladder cancer; however, the investigators could not use clinicopathologic factors to explain the difference in survival.
The investigators acknowledged several limitations of their study. First, more complete data are needed about disease progression or recurrence to determine cancer-specific survival and lymphovascular invasion status. Second, the investigators also noted the possibility of tumor stage misclassification because of a change in treatment protocol.
Disclosure: The study authors reported no conflicts of interest.