Table 1: Five-year Survival Rates for Patients Treated with Radical Cystectomy in Large Radical Cystectomy Series

* 10-year all-cause survival.
** 48% of patients received neoadjuvant or adjuvant radiotherapy and/or chemotherapy.
*** 24% of patients received post-operative radiotherapy. TCC = transitional cell carcinoma, SCC = squamous cell carcinoma, Aden = adenocarcinoma.

It was found that the extent of this nodal involvement determines the survival rate, as the five-year survival rate decreases from 44% to 27% and 0% in N1, N2, and N3 patients, respectively. Moreover, it was proven that the proportion of involved out of the dissected nodes determines the survival rate. It was shown in several prospective and retrospective studies that both the extent of lymphadenectomy and number of dissected nodes determine the survival rate even in negative-node patients. Few studies have included tumor size in the analysis of prognostic factors affecting bladder cancer end-results. Cheng et al. showed that tumor size has a significant effect in determining distant metastasis-free, cancer-specific, and all-cause survival both in the univariate and multivariate analyses. However, Pollack et al. found that the size had no influence on distant metastasis. The cut-off size remained logistically and practically as an important point to be determined. The histological grade had a significant prognostic effect in many studies, yet other studies failed to prove its effect. Similarly, lymphovascular invasion (LVI) had a controversial effect as an independent prognostic factor in different studies. On the other hand, Lotan et al. showed that LVI has its prognostic effect restricted to the node-negative patients.Wider controversy was reported for the effect of tumor angiogenesis. Several studies confirmed the ominous prognostic significance of angiogenesis in TCC, squamous cell (SCC), and adenocarcinoma of the bladder. Others reported a better survival with high angiogenic activity or failed to show any effect on survival. Recently, P53 and P21 were shown to be strong predictors of disease outcome in post-operative multivariate models that adjusted for the effects of other cell cycle regulators and standard pathologic features. The absence of heterogenous retinoblastoma (Rb) gene expression was an independent marker of worse survival compared with positive Rb expression.