Delaying bladder cancer surgery increases mortality

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - In patients with stage II bladder cancer, the risk of death from cancer and other causes increases if surgery is not performed within 12 weeks of diagnosis, U.S. researchers report.

Data from single-center studies have suggested that survival is compromised by a delay in surgery, lead author Dr. John L. Gore, from University of California, Los Angeles, and colleagues note. These studies, however, have largely involved tertiary centers -- highly specialized medical centers -- with referral populations that could confound the results.

In the current study, Gore's team used the Surveillance, Epidemiology, and End Results-Medicare linked data set, a nationally representative database, to examine the impact of delayed surgery on survival of stage II bladder cancer. Included in the study were 441 patients with stage II bladder cancer, which is treated by radical cystectomy, complete removal of bladder, prostate and pelvic lymph node dissection.

Surgery delays of 8, 12, and 24 weeks were evaluated. The authors did not include surgeries performed within 4 weeks of diagnosis as those, they note, are likely to represent emergent cases. The researchers' findings are reported in the March 1st issue of Cancer.

By 1 year, patients who underwent surgery 12 to 24 weeks after diagnosis were 2.0- and 1.6-times as likely to have died from bladder cancer or from any cause, respectively, compared with patients treated within 4 to 8 weeks.

Delays of more than 24 weeks significantly increased the risk of bladder cancer and overall mortality by 2.0-fold.

Older age and more co-existing illnesses were both significantly associated with higher overall mortality rates, the report indicates.

"Prompt treatment remains fundamental to the management of stage II bladder cancer," the authors emphasize. The care and treatment of this patient population should be designed to minimize any delay in surgery beyond 12 weeks.

SOURCE: Cancer March 1, 2009.