Presented October 25th - 28th, 2007 at the 2007 Urological Research Society (URS) Meeting - Napa, California

Introduction: The long-term oncologic outcomes in women requiring radical cystectomy (RC) and orthotopic diversion for transitional cell carcinoma (TCC) of the bladder are not well documented. Herein, we report the oncologic outcomes for 115 women with primary TCC of the bladder who underwent lower urinary reconstruction by means of an orthotopic neobladder following cystectomy.

Methods: From June 1990 to December 2004, 115 women, ages 33 to 83 years (median: 66) underwent an orthotopic neobladder following RC and an extended lymphadenectomy. Outcomes measured included: histologic grade, pathologic stage and subgroup, presence of carcinoma in situ, tumor multifocality, lymphovascular invasion, lymph node density (LND), early complications (within 30 days), adjuvant chemotherapy, recurrence site, recurrence-free and overall survival.

Results: Median follow-up for the entire cohort is 6.1 years (range: 0.02 to 14.3). Three patients (2.6%) died perioperatively (112 patients available for follow-up). 26 patients (22%) experienced an early complication, while 44 patients (38%) experienced a late complication. Tumor was pathologically organ confined (node-negative) in 71 patients (62%), extravesical (node-negative) in 16 (14%), and lymph node positive in 28 (24%). Median overall survival for the entire cohort is 9.4 years (range: 0.02 to 14.3 years). One patient recurred in the urethra. One patient recurred locally. 37 patients (32%) developed distant metastasis. Adjuvant chemotherapy was given to 29 patients (25%). Patients with lymph node involvement were at higher risk for death (RR=3.4, p<0.001) and recurrence (RR=4.1, p<0.001) compared to other pathological subgroups. Within the pathologic subgroups of node-positive disease, patients with greater than a 20% positive LND show significantly worse overall survival (RR=2.1, p=0.086) and recurrence free survival (RR=2.5, p=0.05), when compared to patients with less than or equal to 20% density.

Conclusions: Radical cystectomy and orthotopic diversion remains an appropriate oncologic treatment with excellent local control and low incidence of urethral and upper tract recurrence for women with TCC of the bladder. Long-term survival in this group is comparable to our historical male population undergoing a similar operation and diversion.

Authors: Stein JP, Lee C, Cai J, Miranda G, Penson DF, Skinner DG

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