1751 OUTCOMES IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR RECURRENT BLADDER CANCER FOLLOWING PRIOR PARTIAL CYSTECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: Partial cystectomy (PC) for bladder cancer can have adequate local control in highly selected patients. However, recurrence rates are high and many patients ultimately require radical cystectomy (RC). The prognosis following RC for this specific population has not been previously reported. This study examined the prognostic indicators at the time of RC for this population. METHODS: A retrospective review of the University of Southern California bladder cancer database identified 93 patients who underwent RC for bladder cancer recurrence subsequent to a PC performed at an outside hospital. Information was collected on clinicopathologic and treatment covariates. Data on tumor stage on both the PC and RC tumor specimens were also recorded. Patients with distant metastases, other pelvic cancers, gross disease remaining, or those who had a “palliative” RC were excluded. A group of 2,222 RC patients without prior PC were used to compare the clinicopathologic covariates. RESULTS: Of the 93 patients, 77 met the inclusion criteria. Median follow-up for all patients was 11 years (range, 0-37 years). Median time from PC to RC was 1.45 years (range, 0.1-18.1 years). 5and 10-year recurrence-free survivals were 66 1.1% and 63.0 1.2% for RC only versus 54.3 6.8% and 48.8 6.4% for prior PC (p 0.012). 5and 10-year overall survivals were 57.7 1.1% and 42 1.2% for RC only versus 42.3 5.7% and 33.5 5.6% for prior PC, though this difference did not reach statistical significance (p 0.11). For patients with extravesical extension at RC, the 5-year overall survival was 42.4 2.5% for the RC-only group versus 12.5 8.3% for the prior-PC group (p 0.009). There was no statistically significant difference in survival between the two groups in patients with organ-confined disease. A multivariate analysis for all patients undergoing RC using age, sex, pathologic stage, and prior PC as covariates identified all variables as being significant for survival (p 0.001, p 0.034, p 0.001, and p 0.012, respectively). A similar multivariate analysis for all patients undergoing RC using the above covariates identified sex (p 0.024), pathologic stage (p 0.001) and prior PC (p 0.004) as being significant for recurrence. CONCLUSIONS: In patients with extravesical bladder cancer at radical cystectomy, having undergone a previous partial cystectomy confers an increased risk of recurrence and death. This difference in survival is not seen in patients with organ-confined disease even after having undergone previous partial cystectomy.