1834 DO ROUTINE FOLLOW-UP INVESTIGATIONS FOR DETECTING RECURRENCES AFTER RADICAL CYSTECTOMY BENEFIT THE PATIENT?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive/Metastatic Disease III1 Apr 20101834 DO ROUTINE FOLLOW-UP INVESTIGATIONS FOR DETECTING RECURRENCES AFTER RADICAL CYSTECTOMY BENEFIT THE PATIENT? Gianluca Giannarini, Thomas M. Kessler, Harriet C. Thoeny, Claudia Meissner, and Urs E. Studer Gianluca GiannariniGianluca Giannarini More articles by this author , Thomas M. KesslerThomas M. Kessler More articles by this author , Harriet C. ThoenyHarriet C. Thoeny More articles by this author , Claudia MeissnerClaudia Meissner More articles by this author , and Urs E. StuderUrs E. Studer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1772AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The need for follow-up (FU) and the intensity to detect disease recurrence after radical cystectomy for transitional cell carcinoma (TCC) is a matter of debate. We determined whether the diagnosis of asymptomatic recurrence by routine FU exams is associated with a survival benefit compared to that of symptomatic recurrence after radical cystectomy. METHODS A consecutive series of 418 patients with bladder TCC who underwent extended pelvic lymph node dissection and radical cystectomy with ileal orthotopic bladder substitution were analyzed retrospectively. All patients were prospectively followed up with a standardized institutional protocol. Recurrence patterns were categorized as pelvic, distant and concomitant pelvic/distant recurrences, and secondary urothelial tumors. Cancer-specific and overall survival were assessed for asymptomatic and symptomatic recurrent patients. The effect of age, nerve sparing surgery, tumor stage, lymph node status, adjuvant chemotherapy, mode of recurrence diagnosis and recurrence site on survival was explored with multivariate Cox regression models. RESULTS After a median FU of 44 months (range 3-220), 153/418 (37%) patients were diagnosed with recurrence. Of the 153 recurrent patients, 75 (49%) were diagnosed by routine FU exams and 78 (51%) by symptoms (p=0.99). Routine FU investigations mostly detected lung metastases and urethral recurrences, while symptoms were predominantly due to bone metastases and concomitant pelvic/distant recurrences. Of 18 men with urethral recurrences, 7 are still disease-free after urethra-sparing treatment. Among the other long-term survivors with recurrence, there were patients with lymph node and lung metastases. In multivariate analysis, mode of recurrence diagnosis and site of initial recurrence were the only independent predictors of both cancer-specific and overall survival. Patients with recurrences detected by routine FU investigations and patients with secondary urothelial tumors as recurrence site had a slightly, but significantly higher survival probability. CONCLUSIONS Patients diagnosed during our routine FU with asymptomatic recurrences after radical cystectomy for bladder TCC had a slightly better survival than patients with symptomatic recurrences. Regular surveillance appears to be particularly effective in early detection of urethral recurrences, which can be treated conservatively. In addition, the predominance of lymph node and lung metastases in long-term survivors may justify the use of routine CT scan. Bern, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e712 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gianluca Giannarini More articles by this author Thomas M. Kessler More articles by this author Harriet C. Thoeny More articles by this author Claudia Meissner More articles by this author Urs E. Studer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...