근치적 방광적출술을 시행 받은 근침윤성 방광 이행세포암에서 일차 침윤암과 진행성 침윤암의 예후 및 특성의 차이

Abstract

Purpose We investigated the difference of the prognosis between progressive and primary muscle-invasive bladder cancer treated with radical cystectomy.

Materials and Methods We retrospectively reviewed the medical records of invasive bladder cancer patients who were treated with radical cystectomy between 1986 and 2004. The patients who underwent progression from superficial cancer to muscle invasive cancer within 3 months, and those who underwent bladder preservation or neoadjuvant therapy were excluded. Fifty progressive muscle-invasive cancer patients (the progressive group) and 173 primary muscle-invasive cancer patients (the primary group) were eligible for this study. Univariate and multivariate analysis were performed to identify the associations between the clinicopathological features and survival, and the characteristics between the two groups were compared with using the chi-square test.

Results Among the total patients, 102 patients (45.7%) died of cancer. On univariate analysis, age, gender, tumor size, multiplicity, tumor grade and carcinoma in situ did not influence survival (p>0.05). However, the T stage (p<0.001), lymphovascular invasion (p=0.004), and lymph node involvement (p<0.001) had a significant influence on disease-specific survival. Notably, the 5-year disease-specific survival rate for the primary group (61.1%) was significantly higher than that for the progressive group (36.4%) (p<0.001). On multivariate analysis, T stage (p<0.001), lymphovascular invasion (p=0.036), and the progressive disease (p=0.001) were independent prognostic factors. Comparing the characteristics between the two groups, multiplicity was more frequent in the primary group (p=0.029) and nodal involvement was more frequent in the progressive group (p=0.035).

Conclusions Progressive muscle-invasive bladder cancer has a poorer prognosis than primary invasive cancer. This poor prognosis is thought to be associated with increased lymph node involvement and micrometastasis in the progressive group.