Table of Contents
ISRN Urology
Volume 2011, Article ID 458930, 6 pages
Research Article

Downstaging of TURBT-Based Muscle-Invasive Bladder Cancer by Radical Cystectomy Predicts Better Survival

1Department of Urology, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
2Department of Epidemiology, Biostatistics, and HTA, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
3Department of Cancer Registry and Research, Comprehensive Cancer Centre East, P.O. Box 1281, 6501 BG Nijmegen, The Netherlands
4Department of Urology, Rijnstate Hospital, P.O. Box 9555, 6815 AD Arnhem, The Netherlands
5Department of Urology, Canisius Wilhelmina Hospital, P.O. Box 9015, 6500 GS Nijmegen, The Netherlands
6Department of Urology, St. Jansdal Hospital, P.O. Box 138, 3840 AC Harderwijk, The Netherlands
7Department of Urology, Hospital Gelderse Vallei, P.O. Box 9025, 6710 HN Ede, The Netherlands
8Department of Urology, Slingeland Hospital, P.O. Box 169, 7000 AD Doetinchem, The Netherlands
9Department of Urology, Maas Hospital, P.O. Box 55, 5830 AB Boxmeer, The Netherlands

Received 24 February 2011; Accepted 18 March 2011

Academic Editors: R. B. Moore, A. Natali, and T. Okamura

Copyright © 2011 P. R. van Dijk et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Differences between clinical (cT) and pathological tumor (pT) stage occur often after radical cystectomy (RC) for muscle-invasive bladder cancer. In order to evaluate the impact of downstaging on recurrence and survival, we selected patients from a large, contemporary, population-based series of 1,409 patients with MIBC. We included all patients who underwent RC ( 𝑁 = 6 4 3 ) and excluded patients who received (neo)adjuvant therapy, those with known metastasis at time of diagnosis, and those with nonurothelial cell tumors. Disease outcomes were defined as recurrence-free survival (RFS) and relative survival (RS), as a good approximation of bladder cancer-specific survival. After applying the exclusion criteria, 375 patients were eligible for analysis. Tumor downstaging was found to be common after RC; in 99 patients (26.4%), tumor downstaging to non-muscle-invasive stages at RC occurred. Hydronephrosis at baseline and positive lymph nodes at RC occurred significantly less often in these patients. In 62 patients, no tumor was left in the cystectomy specimen. pT stage was pT1 in 20 patients and pTis in 17 patients. Patients with tumor downstaging have about a 30% higher RFS and RS compared to those without. Consequently, tumor downstaging is a favorable marker for prognosis after RC.