Radikální cystektomie u pacientů s nádory močového měchýře – výsledky u 125 operovaných pacientů

Radical Cystectomy in the Treatment for Bladder Carcinoma: Results of 125 Operated Patients

Background.
Radical cystectomy with pelvic lymphadenectomy and urinary diversion is standard treatment in patients with muscle-invasive and selected high-risk superficial bladder cancers. The aim of our study was to evaluate oncological results and correlate prognosis with the extent of the disease. 

Methods and Results.
Data of 125 patients (33 females and 92 males) with mean age of 59.8 years were analysed. Histological diagnosis was urothelial carcinoma in 114, squamous cell carcinoma in 8 and small-cell carcinoma in 3 patients respectively. During the mean follow-up of 22.4 months the diseasefree survival (DFS) and disease-specific survival (DSS) were evaluated according to the extent of the disease. Tumours were classified as pTa, pT1, pTis in 31 (24.8 %), as pT2 in 39 (31.2 %), as pT3 in 24 (19.2%) and pT4 in 20 (16%) patients respectively. There was no tumour detected in the specimen in 11 (8.8 %) of cases (pT0). Lymph node metastases were confirmed in 36 (28.8 %) of patients. Three-year DFS and DSS were 100 % and 100 % in pT0, 76 % and 87,1 % in pTa, pT1, pTis, 69,2 % and 82,9 % in pT2, 32,9 % and 62,4 % in pT3 and 39,5 % and 36,8 % in pT4 tumours respectively (p=0,0001, p=0,0004). Three-year DFS and DSS reached 69,4 % and 51,8% in patients with negative lymph nodes and 51,8 % and 44,8 % in patients with lymph node involvement (p=0,0008, p<0,0001). 

Conclusions.
DFS and DSS after radical cystectomy depend from the local extent of the tumour and from lymph node status, which is a strong argument for its timely indication. 

Key words:
bladder cancer, radical cystectomy, pelvic lymphadenectomy.