World Journal of Urology

, Volume 28, Issue 4, pp 439–444 | Cite as

Treatment and outcome in muscle invasive bladder cancer: a population-based survey

  • Anna M. LeliveldEmail author
  • Benjamin H. J. Doornweerd
  • Esther Bastiaannet
  • Michael Schaapveld
  • Igle J. de Jong
Original Article



To assess treatments and survival of patients with muscle invasive bladder cancer (MIBC) in the Comprehensive Cancer Center Northern Netherlands (CCCN) region.

Study design and setting

Retrospective cohort analysis. Data of 548 patients with MIBC diagnosed between 1997 and 2002 were collected from the CCCN cancer registry. All had a follow-up of at least 5 years. Logistic regression analysis on treatments as well as survival analysis was performed.


The treatments were radical cystectomy in 205/548 (37.5%) patients. TUR plus radiotherapy in 246 (44.9%) and palliation in 97 (17.7%). Multivariate analysis identified TNM stage (P < 0.0001) and age (P < 0.0001) as independent variables for cystectomy. Hospital type and year of diagnosis were not significant different between patients treated by cystectomy versus other type of treatment. TNM stage (P < 0.0001), age (P = 0.0043), and comorbidity (P = 0.0028) were independent variables for disease-specific survival (DSS) after cystectomy.


In the CCCN region, only 1/3 of patients with MIBC were treated with radical cystectomy. TNM stage and age were identified as main variables for the choice for cystectomy. TNM stage, age, and comorbidity were independent variables for disease-specific survival after cystectomy.


Muscle invasive bladder cancer Cystectomy Survival 


Conflict of interest statement

There is no conflict of interest.


  1. 1.
    Cancer Registry IKC. 7-4-2009. Ref Type: GenericGoogle Scholar
  2. 2.
    Kirkali Z, Chan T, Manoharan M, Algaba F, Busch C, Cheng L et al (2005) Bladder cancer: epidemiology, staging and grading, and diagnosis. Urology 66(6 Suppl 1):4–34CrossRefPubMedGoogle Scholar
  3. 3.
    Stenzl A, Cowan NC, De Santis M, Jakse G, Kuczyk MA, Merseburger AS et al (2009) The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 55(4):815–825CrossRefPubMedGoogle Scholar
  4. 4.
    Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Bohle A, Palou-Redorta J (2008) EAU guidelines on non-muscle-carcinoma of the bladder. Eur Urol 54(2):303–314CrossRefPubMedGoogle Scholar
  5. 5.
    Prout GR Jr, Wesley MN, Yancik R, Ries LA, Havlik RJ, Edwards BK (2005) Age and comorbidity impact surgical therapy in older bladder carcinoma patients: a population-based study. Cancer 104(8):1638–1647CrossRefPubMedGoogle Scholar
  6. 6.
    van Rhijn BW, Burger M, Lotan Y, Solsona E, Stief CG, Sylvester RJ et al (2009) Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol 56(3):430–442CrossRefPubMedGoogle Scholar
  7. 7.
    Sternberg CN, Vogelzang NJ (2003) Gemcitabine, paclitaxel, pemetrexed and other newer agents in urothelial and kidney cancers. Crit Rev Oncol Hematol 46(Suppl):S105–S115CrossRefPubMedGoogle Scholar
  8. 8.
    Sobin LH, Fleming ID (1997) TNM classification of malignant tumors, fifth edition. Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer 80(9):1803–1804CrossRefPubMedGoogle Scholar
  9. 9.
    Snyder C, Harlan L, Knopf K, Potosky A, Kaplan R (2003) Patterns of care for the treatment of bladder cancer. J Urol 169(5):1697–1701CrossRefPubMedGoogle Scholar
  10. 10.
    Visser O, Nieuwenhuijzen JA, Horenblas S (2005) Local recurrence after cystectomy and survival of patients with bladder cancer: a population based study in greater Amsterdam. J Urol 174(1):97–102CrossRefPubMedGoogle Scholar
  11. 11.
    Figueroa AJ, Stein JP, Dickinson M, Skinner EC, Thangathurai D, Mikhail MS et al (1998) Radical cystectomy for elderly patients with bladder carcinoma: an updated experience with 404 patients. Cancer 83(1):141–147CrossRefPubMedGoogle Scholar
  12. 12.
    Clark PE, Stein JP, Groshen SG, Cai J, Miranda G, Lieskovsky G et al (2005) Radical cystectomy in the elderly: comparison of clinical outcomes between younger and older patients. Cancer 104(1):36–43CrossRefPubMedGoogle Scholar
  13. 13.
    Stroumbakis N, Herr HW, Cookson MS, Fair WR (1997) Radical cystectomy in the octogenarian. J Urol 158(6):2113–2117CrossRefPubMedGoogle Scholar
  14. 14.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMedGoogle Scholar
  15. 15.
    Stenzl A, Cowan NC, De Santis M, Jakse G, Kuczyk M, Merseburger AS et al (2009) Guidelines on bladder cancer, muscle invasive and metastatic. European Association of Urology GuidelinesGoogle Scholar
  16. 16.
    Nieuwenhuijzen JA, Pos F, Moonen LM, Hart AA, Horenblas S (2005) Survival after bladder-preservation with brachytherapy versus radical cystectomy; a single institution experience. Eur Urol 48(2):239–245CrossRefPubMedGoogle Scholar
  17. 17.
    Steen-Banasik E, Ploeg M, Witjes JA, van Rey FS, Idema JG, Heijbroek RP et al (2009) Brachytherapy versus cystectomy in solitary bladder cancer: a case control, multicentre, East-Netherlands study. Radiother Oncol 93(2):352–357CrossRefPubMedGoogle Scholar
  18. 18.
    Hamel MB, Henderson WG, Khuri SF, Daley J (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53(3):424–429CrossRefPubMedGoogle Scholar
  19. 19.
    Ghoneim MA, Abol-Enein H (2004) Lymphadenectomy with cystectomy: is it necessary and what is its extent? Eur Urol 46(4):457–461PubMedGoogle Scholar
  20. 20.
    Mills RD, Turner WH, Fleischmann A, Markwalder R, Thalmann GN, Studer UE (2001) Pelvic lymph node metastases from bladder cancer: outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy. J Urol 166(1):19–23CrossRefPubMedGoogle Scholar
  21. 21.
    Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19(3):666–675PubMedGoogle Scholar
  22. 22.
    Mungan NA, Aben KK, Schoenberg MP, Visser O, Coebergh JW, Witjes JA et al (2000) Gender differences in stage-adjusted bladder cancer survival. Urology 55(6):876–880CrossRefPubMedGoogle Scholar
  23. 23.
    Lodde M, Palermo S, Comploj E, Signorello D, Mian C, Lusuardi L et al (2005) Four years experience in bladder preserving management for muscle invasive bladder cancer. Eur Urol 47(6):773–778CrossRefPubMedGoogle Scholar
  24. 24.
    Bochner BH, Kattan MW, Vora KC (2006) Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer. J Clin Oncol 24(24):3967–3972CrossRefPubMedGoogle Scholar
  25. 25.
    Karakiewicz PI, Shariat SF, Palapattu GS, Gilad AE, Lotan Y, Rogers CG et al (2006) Nomogram for predicting disease recurrence after radical cystectomy for transitional cell carcinoma of the bladder. J Urol 176(4 Pt 1):1354–1361CrossRefPubMedGoogle Scholar
  26. 26.
    Dalbagni G, Genega E, Hashibe M, Zhang ZF, Russo P, Herr H et al (2001) Cystectomy for bladder cancer: a contemporary series. J Urol 165(4):1111–1116CrossRefPubMedGoogle Scholar
  27. 27.
    Zaak D, Burger M, Otto W, Bastian PJ, Denzinger S, Stief CG, et al. (2009) Predicting individual outcomes after radical cystectomy: an external validation of current nomograms. BJU Int [Epub ahead of print]Google Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Anna M. Leliveld
    • 1
    Email author
  • Benjamin H. J. Doornweerd
    • 1
  • Esther Bastiaannet
    • 2
  • Michael Schaapveld
    • 2
  • Igle J. de Jong
    • 1
  1. 1.Department of UrologyUniversity Medical Center GroningenGroningenThe Netherlands
  2. 2.Comprehensive Cancer Center North EastGroningenThe Netherlands

Personalised recommendations