AB120. Early radical cystectomy in BCG naive pathological non-muscle invasive bladder cancer: results from a retrospective study with 164 cases

Objective: Bladder cancer is the most common malignancy of urinary system in China. Radical cystectomy with bilateral pelvic lymph node dissection is indicated for high-risk non-muscle invasive bladder cancer after BCG failure. But data regarding early cystectomy before BCG failure is lacking. We aimed to investigate the overall survival and disease-specific survival and related influence factors in patients undergoing radical cystectomy for pathological non-muscle invasive bladder cancer without prior BCG therapy.

Methods: From Jan 2006 to Dec 2012, a total of 524 patients underwent radical cystectomy in Peking University 1st Hospital. Selection criteria as below: (I) pathological stage Ta, T1 or Tis; (II) urothelial carcinoma on pathological diagnosis; (III) no neoadjuvant chemotherapy or radiotherapy before operation; (IV) no intra-vesical BCG treatment before radical cystectomy. A total of 164 patients were included in this study. Clinical data were retrospectively collected.

Results: Of all the patients included, 159 had T1 disease, 5 had CIS only, and no Ta patient was included. Lymph node metastasis was noted in 6 patients. All of the 6 patients were in T1 stage. Of all the patients, 136 underwent standard bilateral lymph node dissection, 5 underwent extended lymph node dissection, while 23 didn’t have any LND. The 5-year OS and disease-specific survival for all the patients was 85% and 91%, respectively. The 5-year OS and disease-specific survival for patients undertaken lymph node dissection was 89% and 95%. The 5-year OS and disease-specific survival for patients didn’t undertake lymph node dissection was 66% and 73%. There was a significant difference both on OS (P=0.012) and DFS (P=0.011) between patients with or without LND. Presence of lymph node metastasis was associated with a decreased survival (P=0.060). Recurrence occurred in 18 patients. And patients with recurrence harbored a significant poorer survival (P<0.001). No significant statistical difference was found on different tumor grade (P=0.931). No other related influence factors were noted.

Conclusions: Patients with pathological non-muscle invasive bladder cancer underwent early radical cystectomy had a favorable prognosis, bilateral pelvic lymph node dissection is essential for this procedure as it gains a survival benefit for the patients.

Keywords: Non-muscle invasive; bladder cancer; radical cystectomy