Long-term patient survival after cystectomy for regional metastatic transitional cell carcinoma of the bladder

The records of 280 patients who underwent pelvic lymphadenectomy and radical cystectomy for transitional cell carcinoma of the bladder between 1971 and 1986 were reviewed. A total of 42 patients had either 1 (stage pN1) or more than 1 (stage pN2) positive lymph nodes (20 and 22 patients, respectively). The over-all 3-year survival rate for patients with positive lymph nodes was 27%, and it was 30 and 18.5% for stages pN1 and pN2 disease, respectively. Kaplan-Meier survival curves revealed a sustained survival advantage for stage pN1 over pN2 disease for the first 3 years (p <0.05) but the difference was not significant at 5 years of followup. Eleven patients with negative lymph nodes but local extension of tumor into the prostatic stroma and/or ducts had a 5-year survival rate of 36%, which equaled the survival of 49 stage pT3b,pN0 cancer patients in the same series. Surgical mortality for the entire population of 280 patients was 2.1% and there was no increase in mortality or morbidity among the node positive patients. Based on the findings of improved survival of stages pN1 and pT3b,N0 cancer patients compared to stage pN2 cancer patients, the tumor, nodes and metastasis classification offers more specific prognostic information than does a single designation of Jewett stage D disease.