Optimal timing of radical cystectomy for patients with invasive transitional cell carcinoma of the bladder

Objective: To determine whether the timing of radical cystectomy affects the survival of patients with invasive transitional cell carcinoma (TCC) of the bladder. Methods: Between January 1985 and June 2000, 167 patients underwent radical cystectomy in our institution. Among them, 50 patients who did not receive any perioperative therapies, including chemotherapy and radiotherapy, were divided into two groups, viz. 28 patients who underwent radical cystectomy within 3 months after the primary diagnosis of invasive bladder cancer (group A) and 22 who underwent radical cystectomy more than 3 months after the primary diagnosis (group B), and we then compared several clinicopathological factors and the survival between these two groups. Results: No significant difference was observed in the patients' clinicopathological characteristics except for age between these two groups. The median follow-up periods for groups A and B were 53 and 48 months, respectively. In groups A and B, an average of 1.2 (range 1-2) and 1.4 (range 1-3) transurethral resections (TURs) of bladder cancer were performed, respectively (p = 0.83). Twenty of 28 patients in group A underwent orthotopic neobladder replacement, whereas only four of 22 underwent neobladder creation (p = 0.001). The recurrence-free, cause-specific and overall survival rates in group A were significantly higher than those in group B (p < 0.05, p < 0.05 and p < 0.05, respectively). Final pathological analysis revealed that the distributions of pathological stage, tumor grade and lymph node metastasis were similar between groups A and B; however, the incidence of vascular involvement in group B was significantly higher than that in group A (p < 0.05), despite the lack of a significant difference in the incidence of vascular involvement in TUR specimens between these two groups. Conclusions: These findings suggest that radical cystectomy in the early disease process, especially before the occurrence of vascular involvement, may result in the improvement of survival of patients with invasive TCC of the bladder.