Introduction and objective: Absence of detected tumor tissue (pT0) on histological examination of radical cystectomy (RC) specimens ranges from 5 to 20%. Although outcomes in these patients tend to be favorable, pT0 does not always mean cure from the disease. We assessed clinical outcomes in bladder cancer patients with no evidence of disease (pT0) following RC.
Materials and Methods: Retrospective analysis of clinical data from patients submitted to RC in a tertiary Urology department between January 2013 and June 2017. Patients lost to follow-up and those with primary non-urothelial tumors (n= 14) were excluded. Patients were divided into 2 groups: Group A (pT0) and group B (tumor present). Considered clinical and oncological variables were: age at the time of RC, gender, preoperative clinical stage (TNM), use of neoadjuvant chemotherapy (NCT). We estimated cancer-specific survival (CSS) and overall survival (OS) through the Kaplan-Meier method (SPSS v20).
Results: Data from 146 patients was collected, with a mean follow-up time of 37,3 ± 22,6 months. Mean age at the time of RC was 65,9 ± 9,5 months, and 87,7% were men. Twenty one patients (14,4%) had pT0N0 histology at the time of RC: prevalence was 43,6% in those who completed NCT, compared to 4,4% in patients submitted to RC alone (p< 0.001). Among group A, clinical stage was ≥ cT2 in 17 patients (81%, all of them received NCT), whereas in 4 (19%) the indication for RC was non-muscle invasive disease. After a mean surveillance period of 46.7 ± 17.7 months, cancer-specific (CSS) and disease-free survival (DFS) were 100%, and overall survival (OS) was 95,2%. Conversely, in group B patients, estimated 5-year CSS and OS were 59,2% and 56%, respectively.
Conclusions: The present study shows that pT0 pathology in RC specimen is associated with a good prognosis regarding CSS and OS. In patients that completed NCT a significant difference in pT0 patients was found, highlighting the possible benefit of this treatment in UBC outcomes. Although stage pT0 confers a benefit in survival, surveillance is still required has some patients experience disease recurrence according to literature.
