INTRODUCTION AND OBJECTIVES: The recurrence of urothelialcancer after radical cystectomy (RC) for bladder cancer (BCa)associates with a reduced survival during follow up. However, dataabout different patterns of recurrence is limited in literature and theimpact of the site of the first recurrence on cancer specific mortality(CSM) still remains to be defined.METHODS: The study included 1,250 consecutive BCa patientstreated with RC at a single tertiary care institution between January 1990 and August 2013. All with recurrence information available. Completeclinical, pathological and follow-up data were available for all the patients.Moreover, status, timing as well as site of first recurrence wereavailable for all patients. Kaplan-Meier curves assessed the time torecurrence and time to survival after first recurrence. Logistic regressionanalyses were performed in order to assess characteristics related todead within 3 months and beyond 12 months after first recurrence.RESULTS: With a mean follow up of 106 months (median: 88),recurrence were recorded for 416 patients (33.2%). Of these, 11 patientsexperienced brain recurrence (2.6%), 63 liver recurrence (15.1%), 61nodes recurrence (14.7%), 66 bone recurrence (15.9%), 30 pelvic recurrence(7.2%), 19 peritoneal recurrence (4.6%), 81 lung recurrence(19.5%), 16 ureter recurrence (3.8%), 17 urethral recurrence (4.1%) and 52(12.5%) patients have unknown site of recurrence. The mean survival afterrecurrence was 10 months (median, IQR). Specifically brain recurrencehas aCSMat 3, 6 and 12months of 45, 36 and 9%, liver of 74, 53 and 32%,lung of 70, 59 and 34%, bone 82, 51, and 23%, pelvic of 78, 33 and 12%,nodal of 93, 76 and 48%, peritoneal 47%, 27% and 9%, ureteral 92, 83,72% and urethral 100, 91 and 51%. Patients with peritoneal or brainrecurrence had the highest rate of death within 3 months after recurrence(p¼0.02 and 0.04 respectively vs. others recurrence).Conversely, patientswith nodal and ureteral recurrence had the highest chance of surviving for12 or more months (p¼0.01 and 0.004 respectively vs. others recurrence).CONCLUSIONS: According to the results of our monocentricseries different time to BCa-specific mortality should be expected accordingto the site of first disease recurrence after RC. This informationmight be helpful to physicians in order to adopt different therapeutic andpalliative strategies for patients according to the site of recurrence.
|Numero di pagine||1|
|Stato di pubblicazione||Published - 2015|