What are the survival rates for bladder cancer after partial cystectomy?

Updated: Apr 03, 2019
  • Author: E Jason Abel, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Many studies have examined the survival of patients with bladder cancer after partial cystectomy. Survival is influenced by tumor stage, grade, and histology. Accurately interpreting the impact of partial cystectomy on overall survival and comparing to results of radical cystectomy data is difficult. Most partial cystectomy series are small (usually < 50 patients) compared to radical cystectomy series of more than 1000 patients. Also, many partial cystectomy series are carefully selected for lower risk tumors prior to surgery, which may influence survival. Furthermore, pelvic lymph node dissection, which has been shown to have a significant survival benefit, [26] is frequently underutilized in partial cystectomy series. [39]

Data from Kassouf et al showed that patients undergoing partial cystectomy who had a prior history of superficial tumors had a decreased overall and advanced recurrence-free survival. [40] This finding is not surprising given that these patients have already demonstrated evidence of a global field effect within the urothelium

When comparing results for a given stage or grade of urothelial bladder cancer, survival outcomes for partial cystectomy series have been worse compared with radical cystectomy series. Five-year survival rates vary from 35-70%, compared with the reported 50-88% survival rate of contemporary radical cystectomy series. However, a recent matched case-control analysis (with patients matched based on age, sex, pathological T stage, and receipt of chemotherapy) showed no difference in metastasis-free or cancer-specific survival when comparing patients undergoing partial cystectomy with those undergoing radical cystectomy, although partial cystectomy patients remain at high risk for recurrence. [41]

Neoadjuvant chemotherapy has been shown in randomized trials to improve overall survival in patients undergoing radical cystectomy [42] although it is unclear whether adjuvant therapy would be equally effective. [43] Adjuvant chemotherapy should be considered in patients with extravesical extension or pelvic lymph node metastases who undergo partial cystectomy.


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