Articles

Urothelial Cancer

Risk Factors and Outcomes of Urethral Recurrence Following Radical Cystectomy

By: Stephen A. Boorjiana lowast , Simon P. Kima, Christopher J. Weighta, John C. Chevilleb, Prabin Thapac and Igor Franka

European Urology, Volume 60 Issue 1, December 2011, Pages 1266-1272

Published online: 01 December 2011

Keywords: Bladder cancer, Radical cystectomy, Urethra, Recurrence, Urothelial carcinoma

Abstract Full Text Full Text PDF (1,0 MB)

Abstract

Background

Conflicting data exist regarding predictors of urethral recurrence (UR) following radical cystectomy (RC) as well as variables associated with survival in patients who experience UR.

Objective

To evaluate the incidence, risk factors, and outcomes of patients with UR.

Design, setting, and participants

We reviewed 1506 patients who underwent RC to identify patients with UR. Median follow-up after RC was 13.5 yr (interquartile range [IQR]: 10.5–18.4).

Intervention

Urethrectomy.

Measurements

Cox proportional hazard regression models were used to analyze predictors of UR and evaluate factors associated with death from urothelial carcinoma (UC) in patients who experienced UR. Cancer-specific survival (CSS) for patients with UR, stratified according to the mode of diagnosis (abnormal urethral cytology vs symptoms), was estimated using the Kaplan-Meier method and compared with the log-rank test.

Results and limitations

UR was identified in 85 patients (5.6%) at a median of 13.3 mo (IQR: 6.1–23.2) after RC, including 80 of 1243 (6.4%) who underwent cutaneous urinary diversion and 5 of 242 (2.1%) who received an orthotopic neobladder (p=0.002). On multivariate analysis, prostate involvement with UC (hazard ratio [HR]: 4.89; p<0.0001), bladder tumor multifocality (HR: 2.34; p=0.001), and orthotopic diversion (HR: 0.34; p=0.02) were significantly associated with the risk of UR. The 5-yr CSS after UR diagnosed by cytology was 80% versus 41% for patients who presented with symptoms (p<0.0001). Patients with symptomatic UR were noted to have significantly higher stage disease at urethrectomy (p=0.04) and tended toward an increased risk of death from UC (HR: 1.94; p=0.08). Limitations included retrospective study design.

Conclusions

Prostate involvement with UC, tumor multifocality, and type of urinary diversion are significantly associated with UR following RC. Although UR is relatively uncommon, the detection of asymptomatic UR was associated with significantly lower stage disease and improved patient survival, suggesting the importance of continued postoperative evaluation of the urethra.

Take Home Message

Prostate tumor involvement, tumor multifocality, and urinary diversion choice are significantly associated with urethral recurrence following cystectomy. Although urethral recurrence is uncommon (5.6%), detection of asymptomatic recurrence was associated with lower-stage disease and improved survival, supporting continued postoperative surveillance.

Keywords: Bladder cancer, Radical cystectomy, Urethra, Recurrence, Urothelial carcinoma.

Footnotes

a Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA

b Department of Pathology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA

c Department of Health Sciences Research, Mayo Medical School and Mayo Clinic, Rochester, MN, USA

lowast Corresponding author. 200 First Street SW, Rochester, MN 55905, USA. Tel. +1 507 284 3982; Fax: +1 507 284 4951.

z.star Presented in podium format at the 2011 annual meeting of the American Urological Association, Washington, DC.

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