Retrospective analysis of survival in muscle-invasive bladder cancer: impact of pT classification, node status, lymphovascular invasion, and neoadjuvant chemotherapy

A range of studies have analyzed prognostic factors in bladder cancer. However, prior cohorts have included heterogeneous pT classification at biopsy and others were derived from large, multi-institutional clinical trials over the span of many years. Our objective was to analyze prognostic factors in a recent radical cystectomy (RC) cohort at a single institution and evaluate outcomes based on current practice patterns. A retrospective analysis of overall survival (OS) was conducted on 180 RC patients with biopsy proven pT2 disease between 2007–2010. Increasing pT classification was a negative predictor of survival. pT was grouped into three categories with pT0/a/is/1/2a surviving longer than pT2b/3a/3b, and pT4 having the worst prognosis. Subclassifying pT2 and pT3 showed no statistically significant difference in survival. Lymphovascular invasion (LVI) and node positivity correlated with decreased OS. Patients treated with neoadjuvant chemotherapy (NAC) had a higher incidence of pT0, yet pN1+ was more common and NAC was not associated with improved OS. This investigation provides reference OS values for patients with pathologically diagnosed muscle-invasive bladder cancer based on current medical guidelines outside the context of a clinical trial. pT4 was the strongest negative predictor of survival, followed by pN1+, the group pT2b/3a/3b, and presence of LVI. NAC patients were noted to have a higher frequency of low pT classification, yet more frequent node positivity, suggesting that pT classification in NAC patients may not accurately reflect remaining tumor burden.