Abstract
BackgroundThere is no criterion for determining whether female patients operated with cystectomy would benefit from hysterectomy. This study compares the oncological outcomes between female patients receiving uterus preserving cystectomy (UPC) and uterus excision cystectomy (UEC).MethodsRetrospective review of 121 female patients with urothelial carcinoma of bladder undergoing UPC (n = 63) or UEC (n = 49) at a single institute between January 2006 and April 2017. Individual postoperative follow-up plans were performed for patients through outpatient visits. Overall survival (OS) and progression-free survival (PFS) estimates were analyzed using Kaplan-Meier method and multivariable Cox regression.ResultsThe median follow-up time was 36 months (interquartile range 16–69). Among patients, 5 (4.1%) had uterus invasion. OS probability (p = 0.939) and PFS probability (p = 0.565) were similar in two groups. In multivariable Cox regression analysis, hysterectomy was not found to be a predictor of OS (hazard ratio 0.908, 95%CI 0.428–1.924, p = 0.801) and PFS (hazard ratio 1.109, 95%CI 0.439–2.805, p = 0.826) after adjusting for age, preoperative clinical stage, pathological stage, pathological nodal stage, neoadjuvant/adjuvant chemotherapy, location of the tumor, and surgical margin. No significant difference of overall survival probability was observed in the patients with organ-confined bladder cancer (p = 0.675) and in patients with no organ-confined bladder cancer (p = 0.695).ConclusionsThe results showed that the rate of uterus invasion was low in patients analyzed in this cohort. It was also found that hysterectomy was not an independent predictor of OS and PFS after radical cystectomy in patients with bladder cancer.
Highlights
Bladder cancer is the ninth most common cancer worldwide [1]
The rationales of hysterectomy are the worse prognosis of female patients and in women there is no anatomical barrier in the vesicocervical areas
Among 143 females, 12 patients who underwent hysterectomy before radical cystectomy and 19 patients who were lost to follow-up were excluded (Fig. 1)
Summary
Despite the 4-fold higher incidence of bladder cancer among males than females, the latter have more advanced tumors at the time of diagnosis [2]. The rationales of hysterectomy are the worse prognosis of female patients and in women there is no anatomical barrier in the vesicocervical areas For patients with advanced urothelial carcinoma of bladder, hysterectomy sufficiently abrogates the tumor. Previous studies reported that the involvement of the uterus in this condition was only 0.3–12.5% [5–10]. There is no criterion for determining whether female patients operated with cystectomy would benefit from hysterectomy. This study compares the oncological outcomes between female patients receiving uterus preserving cystectomy (UPC) and uterus excision cystectomy (UEC)
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