To examine the association between substaging and outcomes following radical cystectomy (RC) in patients with stage III bladder cancer.
We conducted a retrospective observational study using nationwide data from Japan, including 708 patients with stage III bladder cancer who underwent RC. Substaging was based on the American Joint Committee on Cancer's 8th edition. pT3-4aN0 and pTanyN1 were newly defined as stage IIIA, while pTanyN2-3 were defined as stage IIIB. Baseline covariates were balanced using inverse probability of treatment weighting. We analyzed disease-free survival (DFS) and overall survival (OS) across these substages and among the sub-groups: pT3-4aN0, pTanyN1, and pTanyN2-3.
We found evidence that stage IIIB bladder cancer had inferior outcomes than stage IIIA (DFS, hazard ratio, 1.61 [95% confidence interval, 1.28-2.02]; OS, 1.61 [1.25-2.09]). Furthermore, there was evidence of the difference in outcomes between pT3-4aN0 versus pTanyN2-3 (DFS, 1.73 [1.35-2.23]; OS, 1.63 [1.23-2.15]), while no evidence of the difference between pT3-4aN0 and pTanyN1 was observed (DFS, 1.27 [0.96-1.67]; OS, 1.09 [0.78-1.53]). We did not find evidence of heterogeneity in the effects of the substaging on OS by the use of perioperative chemotherapy.
This prognostic study supports the current stage III substaging of patients with bladder cancer who underwent RC. Importantly, there was no difference in OS between pT3-4N0 and pTanyN1 in patients with stage IIIA bladder cancer. These findings may help guide treatment decisions for patients with stage III operable bladder cancer.
International journal of urology : official journal of the Japanese Urological Association. 2025 Feb 05 [Epub ahead of print]
Shuhei Hara, Wataru Fukuokaya, Jun Miki, Rikiya Taoka, Ryoichi Saito, Yoshiyuki Matsui, Shingo Hatakeyama, Takashi Kawahara, Ayumu Matsuda, Taketo Kawai, Minoru Kato, Tomokazu Sazuka, Takeshi Sano, Fumihiko Urabe, Soki Kashima, Hirohito Naito, Yoji Murakami, Makito Miyake, Kei Daizumoto, Yuto Matsushita, Takuji Hayashi, Junichi Inokuchi, Yusuke Sugino, Kenichiro Shiga, Noriya Yamaguchi, Shingo Yamamoto, Keiji Yasue, Takashige Abe, Shotaro Nakanishi, Katsuyoshi Hashine, Masato Fujii, Kiyoaki Nishihara, Hiroaki Matsumoto, Shuichi Tatarano, Koichiro Wada, Sho Sekito, Ryo Maruyama, Naotaka Nishiyama, Hiroyuki Nishiyama, Hiroshi Kitamura, Takahiro Kimura, Japan Urological Oncology Group
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan., Department of Urology, National Cancer Center Hospital, Tokyo, Japan., Department of Urology, Hirosaki University Graduate School of Medicine, Aomori, Japan., Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan., Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan., Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan., Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan., Department of Urology, Akita University Graduate School of Medicine, Akita, Japan., Department of Urology, Graduate School of Life Science, Kumamoto University, Kumamoto, Japan., Department of Urology, Nara Medical University, Nara, Japan., Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan., Department of Urology, Hamamatsu University School of Medicine, Shizuoka, Japan., Department of Urology, Osaka International Cancer Institute, Osaka, Japan., Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan., Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan., Department of Urology, Harasanshin General Hospital, Fukuoka, Japan., Department of Urology, Tottori University Faculty of Medicine, Tottori, Japan., Department of Urology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan., Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan., Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan., Department of Urology, NHO Shikoku Cancer Center, Matsuyama, Ehime, Japan., Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan., Department of Urology, Kurume University School of Medicine, Fukuoka, Japan., Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan., Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan., Department of Urology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan., Department of Urology, Niigata University Graduate School of Medicine, Niigata, Japan., Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan.