UROLOGICAL ONCOLOGY

Treatment delay and prognosis in invasive bladder cancer
Liedberg F, Anderson H, Mansson W
Department of Urology, Lund University Hospital, Lund, Sweden
J Urol. 2005; 174: 1777-81; discussion 1781

• Purpose: We studied treatment delay, and the impact on disease specific survival and stage progression in a series of patients who had undergone cystectomy.
• Materials and Methods: All 141 patients underwent radical cystectomy between 1990 and 1997 due to locally advanced bladder cancer. Treatment delay was defined as time from pathological confirmation of invasive disease to performance of cystectomy, and was registered retrospectively from the patient charts. Two patients received neoadjuvant chemotherapy and were excluded from further analyses. Followup continued until April 2003 with death due to bladder cancer as the end point. Causes of death were retrieved from the Swedish Cause of Death Registry.
• Results: The median treatment delay was 49 days, but was significantly longer for the 71 cases who were referred from other hospitals (63 vs 41 days, p < 0.001). Treatment delay did not influence cumulative incidence of death from bladder cancer. Considering all cases, there was no significant correlation between treatment delay and stage progression. For clinical stage T2 tumors, median treatment delay was 76 days among patients with stage progression compared to 41 and 48 days for those with stage regression and stage equivalence, respectively (p = 0.20).
• Conclusions: Treatment delay was not found to influence disease specific survival in the present study. Furthermore, treatment delay was not significantly longer in cases that progressed compared to those with equal or lower pathological stage in the cystectomy specimen.
  
  
• Editorial Comment
  Does delay of radical cystectomy confer an increased risk of progressive bladder cancer? Several authors have addressed this issue with contradictory results. These authors from Sweden did not find an influence if radical treatment was given before or after 60 days post diagnosis. Median time to surgery (treatment delay) was only 48 days among those alive at the end of follow-up and 4 days longer (52 days) among those who died of bladder cancer.
  Why did the authors chose 60 days threshold? It seems that in a relatively well-organised health care system as in Sweden a relevant delay (> 90 days or 3 months) is a rare event. It is noteworthy to read the editorial comment from M. Cookson who states that the window for curability is not open for all time and may begin to close from 90 days.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany