Late Recurrence after Radical Cystectomy: Patterns, Risk Factors and Outcomes

Abstract

We evaluated the outcome in patients with late recurrence of urothelial carcinoma after radical cystectomy. We identified 2,091 patients who underwent radical cystectomy at our institution between 1980 and 2006. Survival was estimated using the Kaplan-Meier method and compared based on recurrence timing (less than 5 years vs 5 or greater) and location (urothelial vs nonurothelial) using the log rank test. Cox proportional hazard regression models were used to evaluate variables associated with late recurrence and death from bladder cancer. Median postoperative followup was 16.6 years. Late recurrence was identified in 82 patients (3.9%). On multivariate analysis younger age (p = 0.0008), nonmuscle invasive disease (p = 0.01) and prostatic urethral involvement (p <0.0001) were significantly associated with an increased risk of late recurrence. Five-year post-recurrence cancer specific survival was significantly worse after recurrence within 5 years from radical cystectomy vs after late recurrence (17% vs 37%, p = 0.001). Patients with nonurothelial late recurrence had adverse 5-year cancer specific survival compared to those with urothelial late recurrence (19% vs 67%, p <0.0001). On multivariate analysis younger patient age (HR 1.01, p = 0.003), muscle invasive disease (HR 1.31, p <0.0001) and nonurothelial recurrence site (HR 2.76, p <0.0001) but not time to recurrence (p = 0.38) were associated with a significantly increased risk of death from bladder cancer following recurrence after radical cystectomy. Late recurrence is uncommon after radical cystectomy. Younger patient age, nonmuscle invasive disease and prostatic urethral involvement were associated with a significantly increased risk of late recurrence. Interestingly, time to recurrence was not associated with a subsequent risk of patient death.