Among muscle-invasive bladder cancer (MIBC) patients, those with symptom-detected recurrence after radical cystectomy (RC) have a higher mortality risk than those with surveillance-detected recurrence, according to research presented at the recent American Society of Clinical Oncology annual meeting in Chicago.
In a study of 463 RC patients who had recurrent disease — 71 detected by routine surveillance and 107 identified by symptoms — Chelsea Osterman, MD, of the University of Pennsylvania in Philadelphia, and colleagues found that the symptomatic recurrence group had a 74% increased risk of death from the time of surgery and nearly 2-fold increased risk of death from the time of recurrence. The investigators adjusted for disease characteristics, including pathologic tumor stage, positive lymph nodes, lymphovascular invasion, positive surgical margins, and cancer recurrence site, as well as age at RC, obesity, and race.
Patients with asymptomatic recurrence detected during routine surveillance experienced better median overall survival after RC (24.8 vs 15.6 months) and from time of recurrence (13.7 vs 5.2 months). The 5-year OS rate after RC was 14.1% in the asymptomatic group versus 10.3% in the symptomatic group. The 1-year OS rate from the time of recurrence was 55.7% in the asymptomatic group compared with 29.4% in the symptomatic group.
Previous studies may have overestimated survival due to earlier disease detection. “Symptomatic patients were diagnosed with recurrence a median of 1.7 months prior to asymptomatic patients in the present study, yet their median survival from recurrence was 8.2 months less,” Dr Osterman told Renal & Urology News.
The median time to recurrence was 9.7 vs 11.5 months for symptomatic and asymptomatic recurrence patients, respectively – a difference of 52 days.
“The earlier time to recurrence of the symptomatic tumors implies a more aggressive biology,” Dr Osterman explained. “It is not possible to know whether the longer survival of asymptomatic recurrence patients after detection is related to the underlying tumor biology or to early intervention.”
The investigators speculated that fast growing tumors may have a shorter asymptomatic period during which recurrence can be detected.
“These data support consensus guidelines for intensive surveillance post-cystectomy,” Dr Osterman said. “Shortening surveillance intervals post-cystectomy may allow for detection of more aggressive tumors earlier in the asymptomatic phase with the aim of preserving treatment options and performance status.” She encouraged a future randomized trial on surveillance following RC.
All study patients had routine surveillance with chest, abdominal, and pelvic imaging, and blood work. Symptoms triggered additional testing.
Osterman CK, Alanzi J, Kaufman EL, et al. Differences in survival between symptomatic versus asymptomatic recurrence following cystectomy for bladder cancer. 2017 ASCO Annual Meeting. J Clin Oncol 35, 2017 (suppl; abstr e16021)