Objective
To investigate the characteristics and outcomes of late recurrence (LR) in patients
with bladder cancer (BCa) treated with radical cystectomy (RC) and to identify clinicopathologic
predictors of LR and postrecurrence survival.
Materials and Methods
This multicenter study included 1652 BCa patients. LR was defined as occurring more
than 5 years after RC. Differences in postrecurrence overall survival according to
the timing of disease recurrence and the location of recurrence were calculated using
the log-rank test. A logistic regression model was used to identify predictors of
LR, and Cox regression models were used to evaluate variables associated with postrecurrence
overall survival (OS).
Results
Overall, 548 patients experienced disease recurrence. Of these, 67 patients (12.2%)
experienced LR, with a median time to recurrence of 86 months (interquartile range
70.5-107.2). LR was more likely to be located in the urothelium (P = .005). On multivariable analysis, younger age (P = .008) and non–organ confined disease (P = .03) were found to be predictors of LR. Postrecurrence 5-year OS was worse in patients
who experienced early recurrence compared with those with LR (12% vs 25%, P = .02) and in those with nonurothelial recurrence compared to those with disease
recurrence in the remaining urothelium (12% vs 51%, P < .001). Older age (P < .001), non–organ confined disease at RC (P = .02), and nonurothelial recurrence site (P = .002) were independently associated with postrecurrence OS.
Conclusion
LR after RC is an uncommon but non-negligible event that harbors unique characteristics.
LR is associated with better OS compared to early recurrence. Our findings reinforce
the need for lifelong follow-up of BCa patients after RC.
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References
- EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013.Eur Urol. 2013; 64: 639-653https://doi.org/10.1016/j.eururo.2013.06.003
- EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines.Eur Urol. 2014; 65: 778-792https://doi.org/10.1016/j.eururo.2013.11.046
- Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium.J Urol. 2006; 176 (discussion 2422): 2414-2422https://doi.org/10.1016/j.juro.2006.08.004
- Patterns and prognostic significance of clinical recurrences after radical cystectomy for bladder cancer: a 20-year single center experience.Eur J Surg Oncol. 2016; 42: 735-743https://doi.org/10.1016/j.ejso.2016.02.011
- Disease-free survival at 2 or 3 years correlates with 5-year overall survival of patients undergoing radical cystectomy for muscle invasive bladder cancer.J Urol. 2011; 185: 456-461https://doi.org/10.1016/j.juro.2010.09.110
- Predictors of cancer-specific mortality after disease recurrence following radical cystectomy.BJU Int. 2013; 111: E30-E36https://doi.org/10.1111/j.1464-410X.2012.11433.x
- Late oncological occurrences following radical cystectomy in patients with bladder cancer.Eur Urol. 2003; 43: 489-494
- Late recurrence after radical cystectomy: patterns, risk factors and outcomes.J Urol. 2014; 191: 1256-1261https://doi.org/10.1016/j.juro.2013.11.103
- International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy.BJU Int. 2010; 105: 1402-1412https://doi.org/10.1111/j.1464-410X.2010.09217.x
- Impact of histological variants on oncological outcomes of patients with urothelial carcinoma of the bladder treated with radical cystectomy.Eur J Cancer. 2013; 49: 1889-1897https://doi.org/10.1016/j.ejca.2013.02.001
- Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients.J Urol. 2010; 183: 2165-2170https://doi.org/10.1016/j.juro.2010.02.021
- Death certificates are valid for the determination of cause of death in patients with upper and lower tract urothelial carcinoma.Eur Urol. 2012; 61: 854-855https://doi.org/10.1016/j.eururo.2011.12.055
- Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients.J Clin Oncol. 2001; 19: 666-675
- Tumor recurrence in the remnant urothelium of females undergoing radical cystectomy for transitional cell carcinoma of the bladder: long-term results from a single center.J Urol. 2006; 175 (discussion 1271): 1268-1271https://doi.org/10.1016/S0022-5347(05)00643-9
- Upper urinary tract recurrence after radical cystectomy for bladder cancer: incidence and risk factors.Int J Urol. 2012; 19: 229-233https://doi.org/10.1111/j.1442-2042.2011.02916.x
- Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1,069 patients with 10-year followup.J Urol. 2007; 177: 2088-2094https://doi.org/10.1016/j.juro.2007.01.133
- Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.BJU Int. 2016; 117: 563-569https://doi.org/10.1111/bju.13370
- Effect of smoking on outcomes of urothelial carcinoma: a systematic review of the literature.Eur Urol. 2014; 65: 742-754https://doi.org/10.1016/j.eururo.2013.06.010
- Factors influencing post-recurrence survival in bladder cancer following radical cystectomy.BJU Int. 2012; 109: 846-854https://doi.org/10.1111/j.1464-410X.2011.10455.x
Article info
Publication history
Published online: May 12, 2017
Accepted:
April 6,
2017
Received:
January 20,
2017
Footnotes
Financial Disclosure: The authors certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript as follows: Shahrokh Shariat owns or co-owns the following patents: Methods to determine prognosis after therapy for prostate cancer (granted September 6, 2002), Methods to determine prognosis after therapy for bladder cancer (granted June 19, 2003), Prognostic methods for patients with prostatic disease (granted August 5, 2004), and Soluble Fas: urinary marker for the detection of bladder transitional cell carcinoma (granted July 20, 2010). Shariat is an advisory board member of Astellas, Cepheid, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanofi, and Wolff, and is speaker for Astellas, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanochemia, Sanofi, and Wolff. The remaining authors declare that they have no relevant financial interests.
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