NEW YORK (Reuters Health) – When radical cystectomy is not performed within 12 weeks of diagnosis with stage II bladder cancer, all-cause and disease-specific mortality increases, US 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 with referral populations that could confound the results.

In the current study, Dr. Gore’s team used the Surveillance, Epidemiology, and End Results-Medicare linked dataset, a nationally representative database, to examine the impact of delayed surgery for stage II bladder cancer on survival. Included were 441 patients with transitional cell carcinoma who underwent radical cystectomy between 1992 and 2001.

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 and from any cause, respectively, compared with patients treated within 4 to 8 weeks.

Delays of more than 24 weeks increased both the risks of disease-specific and overall mortality by 2.0-fold (p < 0.01 for all). Older age and more comorbid conditions were both significantly associated with overall mortality, the report indicates. “Prompt treatment remains fundamental to the management of stage II bladder cancer,” the authors emphasize. “Those processes that expedite care in this population should be disseminated to minimize the magnitude of the cohort delayed beyond 12 weeks.” Reference:
Cancer 2009;115:988-996.