Although pT0 at radical cystectomy (RC) is associated with excellent prognosis for most patients, some pT0 patients still experience disease recurrence . These heterogeneous outcomes in pT0 patients may be due to the initial treatment modality prior to RC (eg, transurethral resection [TUR] alone vs neoadjuvant chemotherapy [NAC]). Therefore, we compared the outcomes of patients who achieved pT0 after TUR alone versus those who received NAC.
We retrospectively reviewed the data from a multi-institutional cohort comprising 5018 patients treated with RC for urothelial carcinoma of the bladder (UCB). Statistics were performed using SPSS v.17.0 (IBM Corp., Somers, NY, USA). All reported p values are two-sided, and significance was set at 0.05.
Of the 433 pT0 cases, 41 (9.5%) had received NAC, whereas 392 (90.5%) underwent TUR alone. There was no statistical difference between TUR-alone and NAC patients with regard to gender (female: 22% vs 32%; p
We found in univariable but not multivariable analysis that patients who are pT0 after NAC are at higher risk for disease recurrence compared with those who achieve pT0 after TUR alone. One explanation could be the higher rate of non-organ-confined clinical stage in patients selected for NAC. These findings contrast with those of a prospective trial and a retrospective single-center study that failed to find a difference between TUR alone and NAC  and . Both of these studies had similar distributions in clinical stage between TUR-alone and NAC patients. In daily practice, however, NAC is preferentially given to patients who are likely to have non-organ-confined UCB, and pT0 after TUR alone is more likely to be achieved in organ-confined UCB. Thus the finding that NAC is associated with a higher rate of disease recurrence in pT0 patients reflects the underlying biologic potential of the tumor. Despite the preliminary nature of these data, we conclude that pT0 patients remain at risk for disease recurrence and must be followed closely, especially if they have received NAC.
Our study has several limitations such as its retrospective nature. Moreover, the evaluation was performed by multiple pathologists and multiple surgeons, possibly leading to misclassification of some cases.
Conflicts of interest
The authors have nothing to disclose.
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a Weill Medical College of Cornell University, New York, NY, USA
b Medical University of Graz, Graz, Austria
Corresponding author. Brady Urologic Health Center, Weill Medical College of Cornell University, New York-Presbyterian Hospital, 525 East 68th Street, Starr 912A, New York, NY 10065, USA. Tel. +1 212 746 5562; Fax: +1 212 746 8068.
© 2011 European Association of Urology, Published by Elsevier B.V.