Influence of stage discrepancy on outcome in patients treated with radical cystectomy.

AIMS AND BACKGROUND To evaluate the influence of stage discrepancy on clinical outcome in patients with bladder cancer who have undergone radical cystectomy. METHODS AND STUDY DESIGN We reviewed the records of 155 patients who had undergone radical cystectomy. Of the 155 patients (128 males, 27 females), 68 had clinical nonmuscle invasive disease and 87 had muscle invasive disease. Follow-up ranged from 1.0 to 162.4 months (median, 34.3). RESULTS There was no significant difference in overall survival according to clinical T stage (P = 0.483). However, the actuarial overall survival rate of the pathological muscle invasive disease group was significantly less than that in the pathological nonmuscle invasive disease group (P < 0.001). Multivariate analysis with the Cox regression model revealed that lymphovascular invasion (P = 0.001, relative risk [RR] = 2.463) and pathological T stage (P = 0.003, RR = 3.148) were strongly associated with overall survival. There was no difference in cancer-specific survival according to clinical T stage (P = 0.455). However, cancer-specific survival rate of the pathological muscle invasive disease group was significantly less than that in the pathological nonmuscle invasive disease group (P < 0.001). Multivariate Cox proportional hazards model analysis showed that lymphovascular invasion (P = 0.001, RR = 2.545) and pathological T stage (P = 0.002, RR = 3.823) were independent predictors of cancer-specific survival. CONCLUSIONS Our findings indicate that clinical stage determined by transurethral resection is not predictive of clinical outcome after radical cystectomy in patients with bladder cancer.