Cystectomy delays of more than 3 months after the initial diagnosis of muscle-invasive bladder cancer results in decreased overall and disease specific survival, according to a report in the April issue of The Journal of Urology.
“There currently are no standardized guidelines for the appropriate timing of cystectomy,” Dr. Cheryl T. Lee from University of Michigan, Ann Arbor, Michigan told Reuters Health. “However, there is growing evidence that cystectomy should be performed within 3 months of a diagnosis of muscle-invasive (clinical T2 NO M0 – Stage II) disease.” Dr. Lee and colleagues evaluated the timing from the diagnosis of T2 bladder cancer to cystectomy in 214 consecutive patients to assess its impact on survival. Three-year disease-specific survival was 62% for patients who underwent cystectomy within 93 days of diagnosis and 49% for those who underwent surgery later, the researchers note. Three-year overall survival was 51% and 38%, respectively, for patients operated within and beyond 93 days of diagnosis. Patients who had a cystectomy delay of more than 93 days faced about twice the risk of patients who had an earlier cystectomy of dying from any cause or from bladder cancer, according to a multivariate analysis. Nearly half the scheduling delays in patients who underwent cystectomy after 93 days were related to clinical or research appointments, the investigators say. Patient comorbidities accounted for 15% of the delays, and difficulty with decision-making contributed to 12% of the delays. “Rigorous coordination of preoperative counseling, medical clearance, and patient education is required to permit an efficient decision-making process and timely delivery of surgery,” Dr. Lee said. “Patients must undergo cystectomy within 3 months of diagnosis or their survival may be compromised.” “For primary care physicians, expedient referral of high-risk patients with concerning signs, such as hematuria, will help to expedite the diagnosis of urothelial carcinomas,” Dr. Lee added. “For urologists, despite the need for second opinions and the impact of busy surgical schedules, attempts must be made to minimize scheduling issues and other factors that may delay definitive treatment of patients with muscle invasive bladder cancer.” (Source: J Urol 2006;175:1262-1267: Reuters Health: Oncolink: April 2006.)