Partial cystectomy for urothelial carcinoma of the bladder: practice patterns and outcomes in the general population

Introduction — Partial cystectomy (PC) for urothelial carcinoma (UC) in selected patients may avoid the morbidity of radical cystectomy (RC). We describe utilization and outcomes of PC for UC in routine clinical practice.

Methods — All patients with urothelial carcinoma of the bladder (UCB) undergoing PC or RC in Ontario from 1994-2008 were identified using the Ontario Cancer Registry and linked electronic records. Pathology reports were reviewed. Variables associated with PC use were identified using logistic regression. Cox proportional hazards model identified factors affecting cancer-specific (CSS) and overall survival (OS).

Results — A total of 3320 patients underwent PC (n=181; 5%) or RC (n=3139; 95%) from 1994-2008. PC patients were older (36% 80+ years vs. 19%; p<0.001) and more likely to have organ-confined (<pT3) disease (54% vs. 36% RC; p<0.001). Two-thirds (67%) of PC patients did not undergo lymph node dissection (24% for RC; p<0.001). Factors associated with having PC included older age (odds ratio [OR] 1.55; 95% confidence interval [CI] 0.96-2.51 for 70+ years), moderate comorbidity (OR 1.95; 95% CI 1.13-3.37), and surgery outside of a comprehensive cancer centre (OR 1.44; 95% CI 1.03-2.01). Unadjusted five-year OS for PC and RC cases was 34% and 33%, respectively (p=0.455); CSS at five years was 43% and 37% (p=0.045). On adjusted analysis, PC was associated with comparable CSS (hazard ratio [HR] 0.87, 95% CI 0.70-1.09) and OS (HR 0.95, 95% CI 0.79-1.14) as RC.

Conclusions — In routine clinical practice, PC is not common. A substantial proportion of patients treated with PC achieve long-term survival. PC remains a treatment option in selected patients with UCB.