Patients who have undergone radical cystectomy (RC) for muscle-invasive bladder cancer are at increased risk of local disease recurrence if their tumor was in an advanced pathologic stage or they had lymph node invasion, a study found.
Yann Neuzillet, MD, and colleagues at Hôpital Foch in Suresnes, France, studied 903 patients treated with RC for muscle-invasive bladder cancer. Of these, 53 patients (5.9%) experienced local bladder cancer recurrence during follow-up, a proportion in line with results from previous studies, according to an online report in the World Journal of Urology. For all patients, clinicians diagnosed local recurrence using computed tomography (CT). Only four patients presented with isolated pelvic pain. The mean interval from RC to local recurrence was 14.4 months. In addition 50% of cases developed in the year following RC and 98% developed within five years, the investigators found.
The overall median survival was nine months, with 46 of the 53 patients dying from bladder cancer. Thirty-one patients had a subsequent diagnosis of distant metastasis, 20 of them within the following six months. After multivariable analysis, only pathologic stage and lymph node invasion remained associated with local recurrence. The presence of squamous cell carcinoma (which was found in six patients) at pathologic examination was associated with a poorer prognosis following local recurrence compared with pure urothelial carcinoma.
The researchers recommend the use of routine CT scans at regular intervals during postoperative follow-up. CT scans are probably useful in cases of symptoms suggesting local recurrence, mainly pain, they stated.