Survival after primary and deferred cystectomy for stage T1 transitional cell carcinoma of the bladder

Context: The optimal time of cystectomy for nonmuscle invasive bladder cancer (NMIBC) is controversial. Aim: This study aims at comparing cancer-specific survival in primary versus deferred cystectomy for T1 bladder cancer. Settings and Design: Between 1990 and 2004, a retrospective cohort of 204 patients was studied. Materials and Methods: Primary cystectomy at the diagnosis of NMIBC was performed in 134 patients (group 1) and deferred cystectomy was done after failed conservative treatment in 70 (group 2) Both groups were compared regarding patient and tumor characteristics and cancer-specific survival. Statistical Analysis Used: Cancer-specific survival was calculated using the Kaplan-Meier method. Results: Mean follow-up was 79 and 66 months, respectively, in the two groups. Tumor multiplicity was more frequent in group 2; otherwise, both groups were comparable in all characteristics. The definitive stage was T1 in all patients. Although the 3-year (84% in group 1 vs. 79% in group 2), 5-year (78% vs. 71%) and 10-year (69% vs. 64%) cancer-specific survival rates were lower in the deferred cystectomy group, the difference was not statistically significant. In group 2, survival was significantly lower in cases undergoing more than three transurethral resections of bladder tumors (TURBT) than in cases with fewer TURBTs. Conclusions: Cancer-specific survival is statistically comparable for primary and deferred cystectomy in T1 bladder cancer, although there is a non-significant difference in favor of primary cystectomy. In the deferred cystectomy group, the number of TURBTs beyond three is associated with lower survival. Conservative treatment should be adopted for most cases in this category.