Presentation Authors: Marco moschini, Stefania Zamboni*, Lucerne, Switzerland, Jeffrey R. Karnes, Rochester, MN, Francesco Montorsi, Alberto Briganti, Renzo Colombo, Andrea Gallina, Milan, Italy, Agostino Mattei, Philipp Baumeister, Lucerne, Switzerland, Ettore di Trapani, Ottavio De Cobelli, Gennaro Musi, Milan, Italy, Alessandro Antonelli, Claudio Simeone, Brescia, Italy, Luca Boeri, Matteo Soligo, Rochester, MN, Giuseppe Simone, Michele Gallucci, Rome, Italy, Atiqullah Aziz, Rostock, Germany, Evanguelos Xylinas, Paris, France, Shahrokh F. Shariat, Vienna, Austria
Introduction: Recurrence after radical cystectomy (RC) due to bladder cancer (BCa) is a common and deadly event. However, at the time sparse data exists regarding this adverse event and its implication on optimal follow up schemes. We are presenting a multicenter collaboration reporting incidence and pattern of recurrence trying to propose an optimal schedule of follow up after surgery.
Methods: We focused on 2,446 patients treated with RC and pelvic lymph node dissection, between 1990 and 2018, at several European and American referral centers. Clinical recurrences were categorized as cystectomy bed, lymphadenectomy (PLND) template, lung, liver, bone, extra pelvic lymph node, peritoneal carcinomatosis, brain, secondary urothelial cancer or urethral.Kaplan-Meier log-rank, univariable and multivariable competing risk analyses tested the relationship between clinical and pathological factors and the risk to develop recurrence during follow up period.
Results: Of the 2,446 individuals included in the study, 1,402 (57.3%) patients developed a clinical recurrence during the follow up period. Median (IQR) follow-up was 78 (75-83) months. Overall, 315 (12.9%) incur in local recurrence, 152 (6.2%) recurrence in PLND template, 135 (5.5%) lung, 66 (2.7%) liver, 139 (5.7%) bone, 102 (4.2%) extra pelvic lymph nodes, 23 (0.9%) peritoneal carcinomatosis, 29 (1.2%) brain, 45 (1.8%) second urothelial upper urinary tract and 80 (3.3%) urethral. At multivariable competing risk regression, pathological T stage pT3-T4 vs. pT0-2 (Hazard Ratio [HR]: 1.67, Confidence Interval [CI]: 1.33-2.10, p=0.001), presence of node metastases (HR: 2.23, CI: 1.14-4.36, p=0.02) and presence of histological variants (HR: 1.52, CI: 1.32-1.87, p=0.01) were associated with increased risk of harboring recurrence after RC.
Conclusions: Recurrence is a common event in RC patients. We reported detailed recurrence site after radical cystectomy. These findings might be used to develop a new follow up model after RC.