Survival After Radical Cystectomy Improving

Population-based Australian data from 2001-2009 show better 5-year disease-specific and overall survival rates compared with older studies.
Population-based Australian data from 2001-2009 show better 5-year disease-specific and overall survival rates compared with older studies.

Survival outcomes after radical cystectomy (RC) for muscle-invasive bladder cancer have improved in the general population, with 5-year disease-specific and overall survival rates approaching those of academic centers of excellence, according to Australian researchers.

In a study of 804 patients who underwent RC from 2001 to 2009 in New South Wales (NSW), the 5-year disease-specific survival (DSS) and overall survival (OS) rates for the entire cohort were 59.6% and 53.2%, respectively, lead investigator Manish I. Patel, MD, of Westmead Hospital, University of Sydney, and colleagues reported online ahead of print in BJU International. The 5-year DSS for patients with localized, regional, and distant disease was 72%, 51%, and 10%, respectively.

Additionally, compared with patients undergoing RC at low-volume hospitals (0–3 RCs annually), those undergoing RC at high-volume hospitals (7 or more RCs annually) had a 44% increased likelihood of DSS, according to the investigators.

Dr. Patel and his colleagues stated that patients undergoing RC in NSW fared well compared with other contemporary reported outcomes from whole populations. For example, a study of 1994–2008 data from the Ontario Cancer Registry demonstrated a 5-year DSS rate after RC of 33% (BJU Int 2015;116:373-381), and a study of 1997–2002 data from the Comprehensive Cancer Center Northern Netherlands registry found a 5-year DSS after RC of 54% (World J Urol 2010;28:439-444). Researchers who analyzed 1992–2005 data from the Surveillance, Epidemiology and End Results (SEER) database found a 64% 5-year DSS rate after RC (Eur J Cancer 2012;48:1503-1511).

“Compared with older historical population outcomes, the NSW survival outcomes are substantially better,” the authors wrote.

They cited a study of 1993–1996 data from the Northern and Yorkshire Cancer Registry showing an OS rate of only about 30% (Int J Radiat Oncol Biol Phys 2010;77:119-124) and a population-based study of 1990–1995 data in Victoria, Queensland, Australia that found 5-year DSS and OS rates after RC of only 28% and 13%, respectively (ANZ J Surg 2005;75:270-274).

As the populations, hospital systems, and urologist training between NSW and Queensland were similar, Dr. Patel's team wrote, “it is plausible that there has been a substantial improvement in RC outcomes over time in Australia.”

They pointed out that there has been no improvement in outcomes from academic institutions over 3 decades, “which is probably due to high levels of surgical care delivered in these institutions, leaving little room for improvement.”

Although RC survival outcomes in NSW appear better or comparable to other contemporary population studies and close to survival outcomes reported by leading academic institutions, Dr. Patel's team pointed out, the quality of surgery can be questioned because in 36% of cases no record exists of lymph node dissection (LND) having been performed, and the pathologic details of patients who did undergo LND were not available.

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