Introduction & Objectives: Transitional cell carcinoma (TCC) of the bladder has been described as a pan-urothelial disease process and isolated recurrences of the upper tracts, away from surgical margins, support this assessment. However, risk factors for upper tract recurrence (UTR) following radical cystectomy are not well defined. We reviewed our radical cystectomy population to identify prognostic factors associated with an increased risk of UTR. Material & Methods: From our prospective database of 1359 patients treated with radical cystectomy for primary bladder cancer, we identified 1069 patients with TCC treated between 01/1985 and 12/2001. All patients completed routine upper tract surveillance including annual IVP and urine cytology per protocol. Univariate analysis was completed to determine factors predictive of UTR following cystectomy. Results: The median follow-up was 10.3 years. 27 patients (2.5%) recurred in the upper tracts at a median of 3.6 years (range 0.34 to 9.4) following radical cystectomy. 77% of the recurrences presented symptomatically with gross hematuria +/- flank pain (83%), pyelonephritis (12%) or flank pain (6%), while only 23% were identified by routine surveillance imaging. Urethral involvement and disease multifocality were predictive of UTR. Positive ureteral margins noted on either frozen section or final pathology trended toward significance.(table) Males with non-invasive prostatic urethral involvement by TCC or CIS were much more likely to have an UTR than either men without urethral involvement or those with prostatic stromal invasion. Stage, grade, LVI, lymph node status, presence of CIS and urethral margin status were not significantly associated with UTR. Conclusions: These results suggest that UTRs are related to pan-urothelial changes present at the time of cystectomy and reflected by pathologic characteristics including multifocality and urethral involvement. The majority of patients who recur in the UT are not identified by routine surveillance imaging but rather present symptomatically. Thus, the efficacy of surveillance protocols in the population of patients at highest risk for UTR may be improved by more frequent, life-long upper tract imaging.
Upper tract recurrence following radical cystectomy for transitional cell carcinoma.
Buscarini M;
2007-01-01
Abstract
Introduction & Objectives: Transitional cell carcinoma (TCC) of the bladder has been described as a pan-urothelial disease process and isolated recurrences of the upper tracts, away from surgical margins, support this assessment. However, risk factors for upper tract recurrence (UTR) following radical cystectomy are not well defined. We reviewed our radical cystectomy population to identify prognostic factors associated with an increased risk of UTR. Material & Methods: From our prospective database of 1359 patients treated with radical cystectomy for primary bladder cancer, we identified 1069 patients with TCC treated between 01/1985 and 12/2001. All patients completed routine upper tract surveillance including annual IVP and urine cytology per protocol. Univariate analysis was completed to determine factors predictive of UTR following cystectomy. Results: The median follow-up was 10.3 years. 27 patients (2.5%) recurred in the upper tracts at a median of 3.6 years (range 0.34 to 9.4) following radical cystectomy. 77% of the recurrences presented symptomatically with gross hematuria +/- flank pain (83%), pyelonephritis (12%) or flank pain (6%), while only 23% were identified by routine surveillance imaging. Urethral involvement and disease multifocality were predictive of UTR. Positive ureteral margins noted on either frozen section or final pathology trended toward significance.(table) Males with non-invasive prostatic urethral involvement by TCC or CIS were much more likely to have an UTR than either men without urethral involvement or those with prostatic stromal invasion. Stage, grade, LVI, lymph node status, presence of CIS and urethral margin status were not significantly associated with UTR. Conclusions: These results suggest that UTRs are related to pan-urothelial changes present at the time of cystectomy and reflected by pathologic characteristics including multifocality and urethral involvement. The majority of patients who recur in the UT are not identified by routine surveillance imaging but rather present symptomatically. Thus, the efficacy of surveillance protocols in the population of patients at highest risk for UTR may be improved by more frequent, life-long upper tract imaging.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
