Outcomes of patients with clinical CIS-only disease treated with radical cystectomy.

OBJECTIVES: To report the long-term oncological efficacy of radical cystectomy for patients with presumed clinical CIS only disease, to characterize the likelihood of clinical understaging, and to characterize the pattern of recurrence.

METHODS: One thousand six hundred patients have undergone radical cystectomy and pelvic lymph node dissection with intent to cure from August 1971 to December 2005 at the University of Southern California; 27 patients from this cohort who satisfied both the inclusion and exclusion criteria were identified. Relevant clinical and pathological data at time of cystectomy and during follow-up were reported. Overall and recurrence-free survival was estimated using the Kaplan-Meier method.

RESULTS: At time of cystectomy, 33% of patients were found to be clinically understaged. Median follow-up was 94 months. Estimated 5- and 10-year overall survival was 87 and 56%, respectively. Estimated 5- and 10-year recurrence-free survival was 100 and 83%, respectively.

CONCLUSIONS: Excellent long-term survival outcomes can be achieved with radical cystectomy. Radical cystectomy should be strongly considered for patients who have failed prior intravesical therapy. Long-term surveillance of the retained urethra and of the upper tract is essential, as recurrence can occur years following cystectomy. Patients who recur are at high risk of dying from disease.