NHS - Lincoln & Louth County Hospitals, UK 
Private - BMI The Lincoln Hospital
 
Mr.H.VARADARAJ
Consultant Urological Surgeon
   Home      Post Radical Cystectomy Bladder Cancer Prognosis Survival figures
What is the survivial rate, prognosis for radical cystectomy with pelvic lymph node dissection for high grade and muscle invasive bladder cancer ? What is the prognosis for cystectomy after BCG failure ? 
 
Mr.Varadaraj - Poorly differentiated G3, Carcinoma-in-situ and muscle invasive bladder cancer are highly aggressive and serious bladder cancers. While answering this complex question I want to make it clear that predicting outcome for individual patient is very difficult, as there are lot of factors to be taken into account as you will know when you read the details below. It is therefore difficult to give an accurate simple prognosis for each stage of the bladder cancer.
 
FACTORS INFLUENCING OUTCOME: This is complicated by the details of the duration between the diagnosis of the bladder cancer, any treatment thereafter, the response to any neo-adjuvant chemotherapy or BCG intravesical therapy, the time interval before the cystectomy, the stage of the tumor in the bladder, the number of lymph nodes involved or not, total number of lymph nodes removed with density of the positive lymph nodes, lymphovascular invasion etc.
 
Information for the benefit of patients regarding prognosis or survival broken down by sub-stage of bladder cancer, is difficult to get. I am presenting the survival figures for radical cystectomy with lymph node dissection based on information available from worldwide reported results over the last 2 decades and complex analysis in journal articles, including the latest. This will hopefully give relevant information to those patients or their family who are keen to know the prognosis for this aggressive cancer. 
 
I hope patients reading this section do not apply a particular scenario to themselves and get depressed, as it will be wrong to do so. Many may have a better prognosis than indicated by just looking at survival percentages from various series. There are lot of instances where a patient who is expected to have an early recurrence or metastases after a cystectomy lives longer without any recurrence and vice versa.
 
PLEASE DISCUSS YOUR STAGE AND PROGNOSIS WITH YOUR CONSULTANT UROLOGIST WHO WILL BE THE BEST PERSON TO ADVICE YOU APPROPRIATELY and  not go by the figures quoted on this webpage.
 
First of all it is very important to get the stage of your bladder cancer after your Radical cystectomy and pelvic lymph node dissection from your Consultant Urologist/ Urological Surgeon ie., the p-Stage, N-Stage and M-Stage.
 
" p "- Refers to the Pathological stage (p) when the pathologist has looked at your bladder and lymph nodes in details under the microscope and has given the final patholgical stage of your bladder cancer. " pT " - refers to the tumor stage of the bladder cancer in the bladder  " pN " - Lymph node involved or not and stage of lymph nodes. " pM" - Metastases diagnosed at pathology. Please take a print-out of the Stages of Bladder Cancer for your easy understanding as you read the stages and prognosis below.
 
You will need to look at the figures below with your p? N? M? figures given by your Urologist
 
Broadly speaking bladder cancer recurrence-free and overall survival following radical cystectomy and pelvic lymph node dissection is reported
at 5 years in males as 68% and in Females as 66%, 
at 10 years in males as 60% and in Females as 43% 
from one long term study involving 1054 patients 1
 
Going into specific details of pT Stage and pN stage it is a follows:
RADICAL CYSTECTOMY AND NEGATIVE PELVIC LYMPH NODES
 
Pathological stage with the corresponding 5-year survival rate for radical cystectomy plus pelvic lymph node dissection and negative nodes from selected series and analysis:

pTa-pT1 - 85%-100%
pT2 - 63%-83%
pT3 - 31%-56%
pT4a - 19%-53%
2

The node status here will be denoted as N-0 (Zero)
 
What the above means, for example, is that about 31 to 56 out of 100 patient who had stage pT3 tumor without any lymph node involvement will be surviving at 5 years after the cystectomy according to some of the larger series (pT3,pN0,M0 stage).
Over 90% patients with pT1,N0 stage  may survive to 10 years and over with a cure.

RADICAL CYSTECOMY AND PELVIC LYMPH NODES POSITIVE/ INVOLVED
 
N1 stage carries a 5-year survival rate of 26%-44%,
N2 stage carries a 5-year survival rate of 22%-26%, and those with
N3 stage rarely survive longer than 5 years.
 
This survival rate with lymph node positive disease again depends on the extent of the primary tumor in the bladder - pT stage and the factors influencing oucome as outlined above. Majority (over 75%) of the lymph node positive disease are associated with pT3 and pT4 stage tumors.
 
Combining bladder cancer and nodal disease for example
A cure rate of up to 45% can be achieved in patients with nodal disease and a tumor confined to bladder (pT2 or less), whereas lower cure rates (15%-30%) are achieved in patients with nodal disease and the primary tumor extending outside the bladder.
 
As you see there is a wide range in the 5 year survivial figures which depends on which series and from which centre you are looking at, in addition to the factors influencing outcome explained above. You might very well be in the higher end of the figure quoted for your stage and I hope and wish you fall into that category. 
 
CYSTECTOMY AFTER BCG
 
Patients who undergo cystectomy following BCG failure have a 5 year cancer specific survival of 90%. As per another study we know that patients who undergo early cystectomy for BCG failure have a better prognosis and long term survival (of 92%) compared to patients who undergo a delayed cystectomy (of 56%) at 15 years after cystectomy. Studies also have shown that in those patients who undergo cystectomy following intravesical BCG failure, the incidence of metastasis in the Lymph node is above 10% at the time of cystectomy, which leads to a lower 5 year survival.
 
Multiple retrospective reviews suggest that up to one third of patients with high-risk Ta-T1 Grade 3 or carcinoma-in-situ bladder cancer who receive BCG will require Radical Cystectomy and one-third will not survive long term due to metastatic disease.
 
Prostate stroma/gland involvement patients have a 5 year survival of 36%.
 
RADICAL RADIOTHERAPY OUTCOME
 
In clinical stage T3 and T2 disease, external beam radical radiotherapy is associated with a 5-year survival rate of 20%-50% Ref. With neo-adjuvant chemotherapy and newer modalities of Radiotherapy these survival rates may improve and results from trials are awaited. If there is recurrence following radiotherapy one of the option, if the patient is fit for surgery, is salvage cystectomy.
 
Note -
Where you have NOT had a surgery, your bladder cancer stage is referred to with only a "T" and there is no "p" letter used. Therefore if you had Radiotherapy to your bladder the stage referred to is only "T" (stage of tumor based on combination of the pathological stage at TURBT and on CT Scan) and "N" - the node stage based on CT scan finding of your pelvic lymph nodes before your Radiotherapy. M- metastasis is based usually on the CT scan findings before your Radiotherapy or Cystectomy.
 
 
 
 
 
 
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