Characterization of Late Recurrence after Radical Cystectomy in a Large Multicenter Cohort of Bladder Cancer Patients

To investigate the characteristics and outcomes of late recurrence (LR) in bladder cancer (BCa) patients treated with radical cystectomy (RC) and to identify clinico-pathologic predictors of LR and post-recurrence survival.

This multicenter study included 1652 BCa patients. LR was defined as occurring more than 5 years after RC. Differences in post-recurrence overall survival according to the timing of disease recurrence and to the location of recurrence were calculated using the log rank test. Logistic regression model was used to identify predictors of LR and Cox regression models to evaluate variables associated with post-recurrence overall survival (OS).

Overall, 548 patients experienced disease recurrence. Of these, 67 patients (12.2%) experienced LR, with a median time to recurrence of 86 months (IQR 70.5-107.2). LR was more likely to be located in the urothelium (p=0.005). On multivariable analysis, younger age (p=0.008) and non-organ confined disease (p=0.03) were found to be predictors of LR. Post-recurrence 5-years OS was worse in patients who experienced early recurrence (ER) compared to those with LR (12% vs 25%, p=0.02) and in those with non-urothelial recurrence compared to those with disease-recurrence in the remaining urothelium (12% vs 51%, p<0.001). Older age (p<0.001), non-organ confined disease at RC (p=0.02) and non-urothelial recurrence site (p=0.002) were independently associated with post-recurrence OS.

LR after RC is an uncommon but not negligible event that harbours unique characteristics. LR is associated with better OS compared to ER. Our findings reinforce the need to follow-up BCa patients life-long after RC.

Urology. 2017 May 12 [Epub ahead of print]

Francesco Soria, Marco Moschini, Gregory J Wirth, Kilian M Gust, Tobias Klatte, Alberto Briganti, Paolo Gontero, Mohammad Abufaraj, Mehmet Özsoy, Pierre I Karakiewicz, Shahrokh F Shariat

Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria; Geneva Cancer Registry, Global Health Institute, University of Geneva, Switzerland., Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria., Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, University of Montreal, Montreal, Canada., Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA; Department of Urology, Weill Cornell Medical College, New York, USA. Electronic address: .

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