Recurrence-free Survival Following Radical Cystectomy of Patients Downstaged by Transurethral Resection

Craig G. Rogers, Matthew Nielsen*, Patrick J. Bastian, Ganesh S. Palapattu, Bruce J. Trock, Mark P. Schoenberg, Theresa Chan
Johns Hopkins University School of Medicine, Baltimore, MD

Introduction:
We assess bladder cancer recurrence free survival among patients who were noted to have muscle invasive urothelial carcinoma (TCC) on staging transurethral resection (TUR) and subsequently found to have non-muscle invasive TCC at radical cystectomy (i.e., downstaged).
Methods:
The records of 248 consecutive patients who underwent radical cystectomy for TCC at a single academic institution between 1994 and 2002 were retrospectively reviewed. Of these patients, 112 (45%) had documented muscle-invasive disease by TUR prior to radical cystectomy.
Results:
Of the 112 patients with muscle-invasive disease by TUR, 25 (22.3%) were downstaged to non-muscle invasive disease (pT1 or less) at cystectomy, whereas 87 (77.7%) had persistent muscle-invasive disease (pT2 or greater) at cystectomy. Recurrence occurred in 4 (16.0%) downstaged patients compared to 29 (33.3%) non-downstaged patients. Kaplan Meier analysis demonstrated a statistically significant improvement in recurrence-free survival with downstaging (Log rank p=0.008). Multivariate analysis demonstrated a 3-fold reduction in recurrence risk with tumor downstaging (HR=0.33, 95% CI: 0.10-1.12) that approached statistical significance (p=0.075).
Conclusions:
Downstaging from muscle-invasive TCC on TUR to non-muscle invasive TCC at radical cystectomy may be associated with a reduced risk of disease recurrence after adjusting for lymph node status and adjuvant chemotherapy.

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