PURPOSE: To evaluate the oncological impact of postponing radical cystectomy (RC) to allow further conservative therapies prior to progression in a large multicentre retrospective cohort of T1-HG/G3 patients initially treated with BCG. METHODS: According to the time of RC, the population was divided into 3 groups: patients who did not progress to muscle-invasive disease, patients who progressed before radical cystectomy and patients who experienced progression at the time of radical cystectomy. Clinical and pathological outcomes were compared across the three groups. RESULTS: Of 2451 patients, 509 (20.8%) underwent RC. Patients with tumors > 3 cm or with CIS had earlier cystectomies (HR = 1.79, p = 0.001 and HR = 1.53, p = 0.02, respectively). Patients with tumors > 3 cm, multiple tumors or CIS had earlier T3/T4 or N + cystectomies. In patients who progressed, the timing of cystectomy did not affect the risk of T3/T4 or N + disease at RC. Patients with T3/T4 or N + disease at RC had a shorter disease-specific survival (HR = 4.38, p < 0.001), as did patients with CIS at cystectomy (HR = 2.39, p < 0.001). Patients who progressed prior to cystectomy had a shorter disease-specific survival than patients for whom progression was only detected at cystectomy (HR = 0.58, p = 0.024) CONCLUSIONS: Patients treated with RC before experiencing progression to muscle-invasive disease harbor better oncological and survival outcomes compared to those who progressed before RC and to those upstaged at surgery. Tumor size and concomitant CIS at diagnosis are the main predictors of surgical treatment while tumor size, CIS and tumor multiplicity are associated with extravesical disease at surgery.

Città della Salute e della Scienza di Torino University of Studies of Turin Turin Italy

Department of Experimental and Clinical Medicine University of Florence Florence Italy

Department of Surgical Oncological and Stomatological Sciences University of Palermo Palermo Italy

Department of Surgical Science John Radcliffe Hospital University of Oxford Oxford UK

Department of Urology Academic Hospital Uppsala University Uppsala Sweden

Department of Urology CHU de Bicêtre 78 rue du Général Leclerc 94270 Le Kremlin Bicêtre France

Department of Urology Cochin Hospital Paris France

Department of Urology Fundacio Puigvert University of Barcelona Barcelona Spain

Department of Urology Mayo Clinic Rochester MN USA

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Memorial Sloan Kettering Cancer Center New York NY USA

Department of Urology Motol Hospital University of Praha Prague Czech Republic

Department of Urology Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology Rabin Medical Centre Tel Aviv Israel

Department of Urology Radboud University Nijmegen Medical Centre Nijmegen The Netherlands

Department of Urology Santa Chiara Hospital Trento Italy

Department of Urology Sismanoglio Hospital University of Athens Athens Greece

Department of Urology Weill Medical College of Cornell University in New York City New York NY USA

Dipartimento di Urologia Università Vita Salute Ospedale S Raffaele Milan Italy

Facharzt fur Urologie Abteilung fur Urologie Chirurgische Universitats klinik Freiburg Germany

Formerly Department of Biostatistics EORTC Headquarters Brussels Belgium

Genetic and Molecular Epidemiology Group Spanish National Cancer Research Centre Madrid Spain

Oncologic and Reconstructive Urology Department of Urology University Hospitals Leuven Louvain Belgium

Policlinico Tor Vergata University of Rome Rome Italy

Transl Androl Urol. 2018 Dec;7(Suppl 6):S692-S695. doi: 10.21037/tau.2018.11.07. PubMed

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