Presentation Authors: Shawn Dason*, Eugene K. Cha, Cristina Falavolti, Emily A. Vertosick, Lucas W. Dean, Victor A. McPherson, Daniel D. Sjoberg, Nicole E. Benfante, Timothy F. Donahue, Guido Dalbagni, Bernard H. Bochner, New York City, NY
Introduction: Disease recurrence after radical cystectomy (RC) generally occurs within 2 years and has a poor prognosis. Little is known about the small group of patients who experience a late recurrence (>3 years after RC) outside of the urinary tract. In this study, we report our institutional experience with late recurrences and describe the relationships between time to recurrence, management strategies, and survival.
Methods: The study cohort comprised 2315 patients who underwent RC for urothelial carcinoma at our center between 2000-2014, of whom 617 had a recurrence of disease outside of the urinary tract (n=559 3 years after RC). Median follow up for survivors was 2.6 years post-recurrence (IQR 0.95, 4.5). We compared baseline characteristics and post-recurrence management between those with recurrence 3 years after RC. We presented the Kaplan-Meier estimates of survival and used the log-rank test to compare survival between early and late-recurring patients.
Results: Patients with late recurrences had significantly lower consensus T stage, frequency of nodal involvement, and prevalence of multiple recurrence sites (p < 0.05). The average 1-year bladder cancer death rate from the time of recurrence declined from 66% to 50% to 33% for patients with recurrence times of 6 months, 2 years, and 5 years after RC, respectively. For patients who survived at least one year after recurrence, the estimated survival at 5 years after RC was 45% for late recurring patients and 21% for patients who had an early recurrence (p=0.03, Figure 1A). Local consolidative therapy (metastasectomy or radiation) was more common in patients with late recurrence (19% vs. 3.6%, p < 0.0001). In the subset of patients receiving local consolidative therapy, post-recurrence cancer-specific survival in late-recurring patients was significantly better than in early-recurring patients (p=0.02, Figure 1B).
Conclusions: The prolonged lifespan of patients experiencing a late recurrence after RC can be leveraged to individualize management. There is strong rationale for investigating the role of metastasectomy in the management of late recurrences.