230P - Oncological outcomes between partial cystectomy and radical cystectomy in solitary muscle invasive bladder cancer with downgraded T stage

Background

As far as we know, we have yet to establish the long-term cancer outcomes of partial cystectomy (PC) for urothelial carcinoma. Radical cystectomy (RC) is a complex and risky procedure for muscle invasive bladder cancer (MIBC). In some cases, PC with bilateral pelvic lymph node dissection can be an option in selected patients but may compromise oncologic success. We compared the recurrence patterns and survival rates of patients who had either partial or radical cystectomy for MIBC patients with solitary tumor.

Methods

We identified 30 solitary MIBC patients with downgraded staging below cT2 after TURBT or neoadjuvant systemic therapy at our hospital from 2014 to 2021. They had either partial cystectomy or radical cystectomy and all of them had pathological T staging below pT2. We compare the overall survival, cancer specific survival and recurrence pattern including local recurrence and metastasis.

Results

The median postoperative follow-up period was 5 years, with a range of 1 to 8.5 years. When comparing patients who underwent partial cystectomy to those who underwent radical cystectomy, no significant differences were observed in the 5-year distant recurrence-free survival rates (100% vs 94.5%, p = 0.23) or cancer-specific survival rates (91.7% vs 100%, p = 0.43). Furthermore, there were no instances of extravesical pelvic tumor recurrence in either the partial or radical cystectomy groups postoperatively. Among the patients who underwent partial cystectomy, 6 out of 12 (50%) experienced intravesical recurrence of the tumor, and only 1 out of 12 (5.5%) ultimately required conversion to radical cystectomy.

Conclusions

For patients with solitary muscle-invasive bladder cancer that has been downgraded to a stage below cT2, partial cystectomy is a feasible option as it offers a similar metastasis-free survival and cancer-specific survival rate when compared to radical cystectomy. However, it is crucial to acknowledge that patients who received partial cystectomy remain at risk of experiencing recurrence within the bladder. Therefore, it is imperative to provide these patients with appropriate counseling and ongoing monitoring to address this potential risk.

Clinical trial identification

Not applicable

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.