Patients who have no residual disease following radical cystectomy for bladder cancer still should undergo long-term surveillance, investigators concluded.
In a study, a team led by Siamak Daneshmand, MD, of the Keck School of Medicine at the University of Southern California in Los Angeles, found that bladder cancer recurrence and metastasis can develop up to 4 years following surgery, according to study results published in Urologic Oncology.
The study included 234 patients who underwent radical cystectomy for bladder cancer from 2000 to 2019 and had no residual disease on final pathology. The patients had a median age of 67 years. Of the 234 patients, 145 (62%) had no residual disease after transurethral resection of bladder tumor (TURBT) alone (pT0) and 89 (38%) had no residual disease after receiving neoadjuvant chemotherapy (NAC; ypT0).
At a median follow-up of 44 months, the investigators observed 16 recurrences (6.8%), 10 (63%) in the ypT0 group and 6 in the pT0 group. The median time to recurrence was 9 months.
The overall recurrence-free survival (RFS) rate at 1, 3, and 5 years was 94.4%, 92.5%, and 90.8%, respectively. The ypT0 group had significantly worse 2- and 5-year RFS rates compared with the pT0 group (85% and 84% vs 99% and 95%, respectively), Dr Daneshmand’s team reported.
Delayed recurrences were observed as late as 34.4 months and 49.9 months in the ypT0 and pT0 groups, respectively. The investigators observed no recurrences beyond 5 years. The investigators observed no significant difference in overall survival (OS) between the groups.
Of the 16 patients who experienced recurrence, 9 (56%) had clinical locally advanced disease, 6 (38%) had muscle-invasive disease, and 1 (6%) had noninvasive disease. The lungs were the most common site of metastases (5 patients, 31%).
The authors noted that their study was based on a single-institution retrospective analysis at a tertiary care center, which may introduce selection bias and limit the generalizability of their results. Further, they pointed out that their study cohort “may not be large enough to detect certain differences in recurrence patterns or risk factors.”
Nevertheless, Dr Daneshmand and colleagues wrote that their study “highlights the importance of surveillance of patients with no residual disease after [radical cystectomy], especially in the post-NAC setting.”
The investigators noted that guidelines allow for surveillance imaging intervals of up to 6 to 12 months after RC, “closer follow-up may be needed in ypT0 patients compared to the pT0 group, especially in the first 2 years. Special attention should be paid to those with the higher clinical stage before NAC since our findings support the impact of this factor on both RFS and OS.”
On univariate analysis, Dr Daneshmand’s team found that NAC and clinical T stage (cT3 or higher) were significantly associated with 6.5- and 4.3-fold increased risks for recurrence. Age older than 65 years and cT3 or higher disease were significantly associated with 3.2- and 2.3-fold increased risks for death, respectively.
Douglawi A, Ghoreifi A, Lee R, et al. Recurrence patterns in bladder cancer patients with no residual disease (pT0N0) at radical cystectomy: A 20-year experience. Urol Oncol. Published online November 22, 2022. doi:10.1016/j.urolonc.2022.09.013