Multifactorial, site‐specific recurrence model after radical cystectomy for urothelial carcinoma

Umbreit, Eric; Crispen, Paul L.; Shimko, Mark; Farmer, Sara A.; Blute, Michael L.; Frank, Igor

doi:10.1002/cncr.25202

Cited by 46 publications

(24 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous reports have demonstrated that the median time to secondary urothelial carcinomas ranges from 3.3 to 4.3 yr [25,26], and rates of urinary tract recurrences are as low as 1.7% at 5 yr [19]. In accordance with our study design, we reported events within 2 yr of surgery.…”

Section: Discussionsupporting

confidence: 84%

Recurrence Patterns After Open and Robot-assisted Radical Cystectomy for Bladder Cancer

et al. 2015

View full text Add to dashboard Cite

Background Concerns remain whether robot-assisted radical cystectomy (RARC) compromises survival because of inadequate oncologic resection or alteration of recurrence patterns. Objective To describe recurrence patterns following open radical cystectomy (ORC) and RARC. Design, setting, and participants Retrospective review of 383 consecutive patients who underwent ORC (n = 120) or RARC (n = 263) at an academic institution from July 2001 to February 2014. Intervention ORC and RARC. Outcome measurements and statistical analysis Recurrence-free survival estimates were illustrated using the Kaplan-Meier method. Recurrence patterns (local vs distant and anatomic locations) within 2 yr of surgery were tabulated. Cox regression models were built to evaluate the effect of surgical technique on the risk of recurrence. Results and limitations The median follow-up time for patients without recurrence was 30 mo (interquartile range [IQR] 5–72) for ORC and 23 mo (IQR 9–48) for RARC (p = 0.6). Within 2 yr of surgery, there was no large difference in the number of local recurrences between ORC and RARC patients (15/65 [23%] vs 24/136 [18%]), and the distribution of local recurrences was similar between the two groups. Similarly, the number of distant recurrences did not differ between the groups (26/73 [36%] vs 43/147 [29%]). However, there were distinct patterns of distant recurrence. Extrapelvic lymph node locations were more frequent for RARC than ORC (10/43 [23%] vs 4/26 [15%]). Furthermore, peritoneal carcinomatosis was found in 9/43 (21%) RARC patients compared to 2/26 (8%) ORC patients. In multivariable analyses, RARC was not a predictor of recurrence. Limitations of the study include selection bias and a limited sample size. Conclusions Within limitations, we found that RARC is not an independent predictor of recurrence after surgery. Interestingly, extrapelvic lymph node locations and peritoneal carcinomatosis were more frequent in RARC than in ORC patients. Further validation is warranted to better understand the oncologic implications of RARC. Patient summary In this study, the locations of bladder cancer recurrences following conventional and robotic techniques for removal of the bladder are described. Although the numbers are small, the results show that the distribution of distant recurrences differs between the two techniques.

show abstract

Section: Discussionsupporting

confidence: 84%

Recurrence Patterns After Open and Robot-assisted Radical Cystectomy for Bladder Cancer

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Fifth, the dimension of our cohort and the lack of data regarding the presence of lymphovascular invasion at TURBT have limited the possibility to perform analyses by subgroups of patients. Lastly, our evaluation of recurrence-free survival includes any recurrences, whereas it would be probably advisable to perform a separate analysis for evaluation of c-TURBT just in the local ones, even if in several works the relationship between pathologic T stage and any kind of recurrence, included the distant ones, was demonstrated [26][27][28]. Despite these limitations, our analyses provided worthwhile information for the effectiveness of c-TURBT over adverse pathological features and survival outcomes in overall population who undergoes RC with curative intent.…”

Section: Discussionmentioning

confidence: 99%

The impact of completeness of last transurethral resection of bladder tumors on the outcomes of radical cystectomy

et al. 2019

View full text Add to dashboard Cite

Purpose To evaluate the role of a complete transurethral resection of bladder tumors (c-TURBT) on oncological outcomes after radical cystectomy (RC) and its relationship with adverse pathological features. Methods We retrospectively analyzed data of 727 patients treated with RC and bilateral pelvic lymph node dissection at three tertiary referral centers. Possible c-TURBT was reported by the treating surgeon. Multivariable Cox regression analyses were used to assess the relationship of c-TURBT and survival outcomes after surgery in 1:1 propensity score-matched cohort adjusted for age and gender. Moreover, multivariable logistic regression (MVA) was built to predict the relationship between c-TURBT and pT3-T4 stages at RC, lymph node invasion (LNI) and positive soft tissue surgical margin (STSM). Results A total of 433 (60%) patients received a c-TURBT. 3.0% of patients with a c-TURBT achieved a pT0-pTa-pTis status vs. 2.0% of patients with incomplete TURBT. At multivariable Cox regression analyses, c-TURBT was not associated with survival outcomes. At MVA, incompleteness of TURBT was significantly associated with a pT3-T4 stage [odds ratio (OR) 8.04, 95% confidence interval (CI) 2.33-27.67, p = 0.001]. No significant association was found between c-TURBT, LNI and STSM. Conclusion We found a low rate of achievement of pT0 stage at RC. An incomplete TURBT before RC represented a predictor of pT3-T4 stages, but no effect of a c-TURBT was shown on survival outcomes. Given the current inadequacy of clinical staging strategies with more than 50% of extravesical disease being under-staged, our results could improve patients selection for NAC, driving the decision-making in doubtful cases.

show abstract

“…A recent study found no significant difference in recurrence or survival associated with BMI in a Japanese population diagnosed with upper tract urothelial carcinoma, which is a rare, aggressive malignancy representing just 5% of urothelial neoplasms. 16,17 A study of patients with muscleinvasive urothelial carcinoma who are treated by radical cystectomy found a decreased risk of osseous recurrence; however, this study examined only tumor recurrences at secondary sites following radical cystectomy 18 and is not generalizable to the majority of bladder cancer patients who present with noninvasive UCC.…”

Section: Introductionmentioning

confidence: 99%

Body mass and smoking are modifiable risk factors for recurrent bladder cancer

Wyszynski

Tanyos

Rees

et al. 2013

Cancer

View full text Add to dashboard Cite

Background In the Western world, bladder cancer is the fourth most common cancer in men and the eighth most common in women. Recurrences frequently occur and continued surveillance is necessary to identify and treat recurrent tumors. Efforts to identify risk factors that are potentially modifiable to reduce the rate of recurrence are needed. Methods We investigated cigarette smoking behavior and body mass index (BMI) at diagnosis for associations with bladder cancer recurrence in a population-based study of 726 bladder cancer patients in New Hampshire, US. Patients diagnosed with non-muscle invasive urothelial-cell carcinoma were followed to ascertain long-term prognosis. Analysis of time to recurrence was performed using multivariate Cox regression models. Results Smokers experienced shorter time to recurrence (continuing smoker HR 1.51 95%CI 1.08-2.13). Although being overweight (BMI>24.9 kg/m2) at diagnosis was not a strong independent factor (HR 1.33 95%CI 0.94-1.89), among continuing smokers, being overweight more than doubled the risk of recurrence compared to smokers of normal weight (HR 2.67 95%CI 1.14-6.28). Conclusions These observational results suggest that adiposity is a risk factor for bladder cancer recurrence, particularly among tobacco users. Future intervention studies are warranted to evaluate whether both smoking cessation and weight reduction strategies reduce bladder tumor recurrences.

show abstract

Multifactorial, site‐specific recurrence model after radical cystectomy for urothelial carcinoma

Abstract: Scoring algorithms based on independent predictors of site-specific recurrence were presented. These models may be used to tailor postoperative surveillance to the individual patient based upon clinicopathologic features at the time of cystectomy.

Cited by 46 publications

References 35 publications

Recurrence Patterns After Open and Robot-assisted Radical Cystectomy for Bladder Cancer

Recurrence Patterns After Open and Robot-assisted Radical Cystectomy for Bladder Cancer

The impact of completeness of last transurethral resection of bladder tumors on the outcomes of radical cystectomy

Body mass and smoking are modifiable risk factors for recurrent bladder cancer

Contact Info

Product

Resources

About