Outcomes after disease recurrence in patients with urothelial carcinoma of the bladder treated with radical cystectomy are variable, but the majority of patients die from the disease within 2 years after disease recurrence.
Knowledge about prognostic factors that may influence survival after disease recurrence is limited. We found that outcomes after disease recurrence in patients with urothelial carcinoma of the bladder are significantly affected by common clinicopathological factors. In addition, a shorter time from surgery to disease recurrence is significantly associated with poor outcomes. These factors should be considered when scheduling salvage chemotherapy protocols/clinical trials.
OBJECTIVE:To describe the natural history following disease recurrence after radical cystectomy (RC) and to identify prognostic factors that influence cancer-specific survival with special focus on time from RC to disease recurrence.
METHODS:We identified 1545 patients from 16 international institutions who experienced disease recurrence after RC and bilateral lymphadenectomy. None of the patients received preoperative chemotherapy; 549 patients received adjuvant chemotherapy. A multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence.
RESULTS:The median cancer-specific survival time after disease recurrence was 6.9 months (95% CI 6.3-7.4). Overall, 1254 of 1545 patients died from urothelial carcinoma of the bladder and 47 patients died from other causes. The actuarial cancer-specific survival estimate at 12 months after disease recurrence was 32%. On multivariable analysis, non-organ-confined tumour stages (hazard ratio [HR] 1.38, P= 0.002), lymph node metastasis (HR 1.25, P < 0.001), positive soft tissue surgical margin (HR 1.32, P= 0.002), female gender (HR 1.21, P= 0.003), advanced age (HR 1.16, P < 0.001) and a shorter interval from surgery to disease recurrence (P < 0.001) were significantly associated with cancer-specific mortality. The adjusted risk of death from cancer within 1 year after disease recurrence for patients who recurred 6, 12 and 24 months after surgery was 70%, 64% and 60%, respectively.
CONCLUSIONS: Over two-thirds of patients who experience disease recurrence of urothelial carcinoma of the bladder after RC die within 12 months. Common clinicopathological factors are strongly associated with cancer-specific mortality. A shorter time from surgery to disease recurrence is significantly associated with poor outcomes. Accurate risk stratification could help in patient counselling and decision-making regarding salvage treatment.
Written by:
Rink M, Lee DJ, Kent M, Xylinas E, Fritsche HM, Babjuk M, Brisuda A, Hansen J, Green DA, Aziz A, Cha EK, Novara G, Chun FK, Lotan Y, Bastian PJ, Tilki D, Gontero P, Pycha A, Baniel J, Mano R, Ficarra V, Trinh QD, Tagawa ST, Karakiewicz PI, Scherr DS, Sjoberg DD, Shariat SF. Are you the author?
Weill Cornell Medical College, New York Presbyterian Hospital Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Medical Center, Dallas, TX, USA; University Medical Center Hamburg-Eppendorf, Hamburg Caritas St Josef Medical Centre, University of Regensburg, Regensburg Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany; Cochin Hospital, APHP, Paris Descartes University, Paris, France; Hospital Motol, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic; University of Montreal, Montreal, QC, Canada; University of Padua, Padua University of Turin, Urologia 1 Molinette Hospital, Torino General Hospital of Bolzano, Italy; Rabin Medical Center, Petah-Tikva, Israel.
Reference: BJU Int. 2012 Sep 3. Epub ahead of print.
doi: 10.1111/j.1464-410X.2012.11433.x
PubMed Abstract
PMID: 22938654
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