Late Recurrences of Bladder Cancer - Expert Commentary

Patients with muscle-invasive and high-risk non-muscle invasive urothelial carcinoma of bladder who undergo radical cystectomy (RC) and lymphadenectomy are closely monitored for recurrence.  The risk of disease recurrence is highest during the first few years. Defining late recurrence patterns is critical for designing optimal surveillance and management strategies. A recent study published by Yoo et al. evaluated late recurrence rates, outcomes, and prognostic factors in UCB patients after RC.1 The investigators included 570 bladder cancer patients who underwent RC and bilateral pelvic lymph node dissection.

The study identified 214/570 patients who had disease recurrence. The majority of recurrences occurred early with a median 13.0 (interquartile range [IQR], 6.0–32.0) months to recurrence. 20 (9.3%) patients had a late recurrence. Median time from RC to recurrence was 85.0 (IQR 72.5–124.5) months for the late recurrence group. There were no statistically significant differences in post-recurrence disease-specific survival at five years between the late recurrence (21.6%) and the early recurrence groups (14.1%) (p = 0.344).

Older age (Hazard Ratio HR 1.03, 95% CI 1.01–1.05, p = 0.001), nonorgan-confined disease at RC (HR 1.73, 95% CI 1.15–2.61, p = 0.008), and lymph node invasion (HR 1.58, 95% CI 1.01–2.45, p = 0.043) predicted post-recurrence 5-year disease-specific survival.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

Reference:
1. Yoo SH, Kim H, Kwak C, Kim HH, Jung JH, Ku JH. Late Recurrence of Bladder Cancer following Radical Cystectomy: Characteristics and Outcomes. Urol Int. 2019 Aug 28:1-6. doi: 10.1159/000502656.

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