Therapeutic efficacy of salvage cystectomy. Do results reflect natural history of bladder cancer?

In a retrospective review of patients who underwent salvage cystectomy, patients with muscle-invasive cancers who had initially presented with tumors that were pathologically TA or T1 appeared to have a better prognosis than those who had muscle-invasive (T2 or T3) cancers on initial clinical presentation. Prognosis in each group appeared to correlate with the stage of tumor at initial clinical presentation rather than with stage of tumor at recurrence after radiation therapy. Prognosis also appeared to correlate with architectural configuration of the presenting tumor as well as the type of invasion. Thus, papillary lesions with muscle invasion by a broad front of histologically cohesive blocks of cells appeared to have a better prognosis than did solid or nodular lesions that appeared to invade the muscle wall in a tentacular fashion with fingerlike tumor cell extensions that seemed to percolate through the bladder wall. Taken together, the results of treatment in these patients may have represented the intrinsic nature of their particular tumors.