PURPOSE: We evaluated the outcome in patients with late recurrence of urothelial carcinoma after radical cystectomy.
MATERIALS AND METHODS: We identified 2,091 patients who underwent radical cystectomy at our institution between 1980 and 2006. Survival was estimated using the Kaplan-Meier method and compared based on recurrence timing (less than 5 years vs 5 or greater) and location (urothelial vs nonurothelial) using the log rank test. Cox proportional hazard regression models were used to evaluate variables associated with late recurrence and death from bladder cancer.
RESULTS: Median postoperative followup was 16.6 years. Late recurrence was identified in 82 patients (3.9%). On multivariate analysis younger age (p = 0.0008), nonmuscle invasive disease (p = 0.01) and prostatic urethral involvement (p < 0.0001) were significantly associated with an increased risk of late recurrence. Five-year post-recurrence cancer specific survival was significantly worse after recurrence within 5 years from radical cystectomy vs after late recurrence (17% vs 37%, p = 0.001). Patients with nonurothelial late recurrence had adverse 5-year cancer specific survival compared to those with urothelial late recurrence (19% vs 67%, p < 0.0001). On multivariate analysis younger patient age (HR 1.01, p = 0.003), muscle invasive disease (HR 1.31, p < 0.0001) and nonurothelial recurrence site (HR 2.76, p < 0.0001) but not time to recurrence (p = 0.38) were associated with a significantly increased risk of death from bladder cancer following recurrence after radical cystectomy.
CONCLUSIONS: Late recurrence is uncommon after radical cystectomy. Younger patient age, nonmuscle invasive disease and prostatic urethral involvement were associated with a significantly increased risk of late recurrence. Interestingly, time to recurrence was not associated with a subsequent risk of patient death.
Written by:
Linder BJ, Boorjian SA, Hudolin T, Cheville JC, Thapa P, Tarrell RF, Frank I. Are you the author?
Department of Urology, Mayo Clinic, Rochester, Minnesota; Department of Pathology, Mayo Clinic, Rochester, Minnesota; Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Reference: J Urol. 2013 Dec 10. pii: S0022-5347(13)06078-3.
doi: 10.1016/j.juro.2013.11.103
PubMed Abstract
PMID: 24333110
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