Comparative analysis between radical cystectomy and trimodality therapy for clinical stage II bladder cancer – Experience from a tertiary referral center

Objectives: To analyze the clinicopathologic characteristics and oncologic outcomes between radical cystectomy (RC) and trimodality therapy (TMT) for patients with clinical stage II bladder urothelial carcinoma (UC). Methods: Between January 2004 and September 2013, the medical records of 93 consecutive patients with clinical stage II bladder cancer (cT2N0M0) diagnosed at National Taiwan University Hospital were retrospectively reviewed, including 66 with RC and 27 with TMT. Univariate and multivariate Cox regression analyses were performed to determine prognostic factors. Results: The median follow-up time was 34.1 months. There were no significant differences between the TMT and RC group with respect to age, gender, cancer grade and the presence of hydronephrosis. The 5-year overall survival rate (74%) and the 5-year cancer specific survival rate (76%) showed comparable results between RC and TMT group. The overall recurrence rate was 38 % (RC: 41% vs. TMT: 30%, p=0.35). Presence of hydronephrosis demonstrated statistically significant association with tumor recurrence (HR: 2.05, 95% CI 1.04-4.04, p=0.04). Patients with diabetes mellitus (DM) were independently correlated with poorer overall survival (HR: 2.73, 95% CI 1.09-6.82, p=0.03) and cancer-specific survival (HR: 3.32, 95% CI 1.28-8.65, p=0.01.) Conclusions: TMT is an optimal therapeutic option in selected patients with clinical stage II bladder UC. In our study, despite the method of treatment, presence of hydronephrosis increased cancer recurrence risk and DM demonstrated a significantly negative effect on overall survival and cancer-specific survival.