Prognostic role of delay before radical cystectomy: Retrospective analysis of a single-center cohort with 376 patients

BACKGROUND: According to International Guidelines radical cystectomy (RC) should not be delayed over 90 days to prevent the risk of intercurrent progression and worse survival. Nevertheless, such a recommendation relies on a few retrospective studies reaching non-univocal conclusions. Aim of the present study was to investigate if the latency between diagnosis and cystectomy (LDC) is related to prognosis after RC . METHODS: Retrospective analysis of database collecting complete information on patients undergone RC at single institution since 2004. The cases with an LDC <15 or >360 days or submitted to neo-adjuvant chemotherapy or with distant metastasis were excluded. Uni- and multivariate analyses assessed the relationship between LDC upstaging, progression-free and overall survival. RESULTS: The data of 376 patients were analyzed; mean/median LDC was 83/76 days and 124 patients (33%) had LDC>90 days. LDC was shorter in younger patients with first diagnosis of more advanced BC at clinical staging; accordingly, patients with LDC<90 days had more advanced disease also at final pathology. Prevalence of pathological upstaging was 37%; in case of upstaging LDC was 75 days vs. 72 days (P=0.4629). Multivariable regression models adjusted for pathological local and lymph nodal stage showed that LDC, continuous or dichotomized at 30/60/90/120/180/240 days was not related to progression-free or overall survival. The retrospective design of study is the main limitation of the study. CONCLUSION S: In our experience nor the risk of upstaging, neither survival after RC were related to LDC. Even if these results should not discourage any effort to perform surgery expeditiously, the window of opportunity for RC might not be delimited by a predetermined threshold