Does early cystectomy improve survival of patients with high-risk superficial bladder tumors?

Purpose: Comparison of survival after early and delayed cystectomy in patients with high risk superficial bladder tumors. Patients and Methods: Of 307 patients with high risk superficial bladder tumors treated initially with transurethral resection and BCG-therapy, 90 (29%) underwent a cystectomy for recurrent tumor during a follow-up period of 15 to 20 years. Disease-specific survival distribution of these 90 patients was determined relativ to the indications for and time of cystectomy. Results: A total of 44 (49%) of the 90 cystectomized patients survived for a median time of 96 months. Of 35 patients with recurrent superficial bladder tumors initially treated with BCG, 92% of those cystectomized within 2 years after BCG-therapy survived as compared to 56% who had undergone cystectomy after 2 years of follow-up. Of 55 patients with recurrent muscle-invasive bladder tumors, 41% survived when cystectomy was performed within 2 years compared to 18% after 2 years. A multivariate analysis showed that early cystectomy improved survival in patients with non-muscle-invasive tumor relapse. Conclusion: Earlier cystectomy improves the long-term survival of patients with high risk superficial bladder tumors who fail BCG-therapy.