What is the recurrence rate of bladder cancer after partial cystectomy?

Updated: Apr 03, 2019
  • Author: E Jason Abel, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The major disadvantage of partial cystectomy compared with radical cystectomy is an increased bladder recurrence rate in addition to metastatic recurrence. Recurrence also implies a risk of disease progression, metastasis, and death from cancer. In many patients, salvage with radical cystectomy is not possible, and some series report high death rates in patients who recur. Recurrence rates associated with partial cystectomy have been reported as 19-78%. Relapses seem to be influenced by tumor stage T3b, poorly differentiated (grade III) tumors, and tumor size (>4 cm). Various studies and their corresponding recurrence rates are as follows:

Table 3. Various Studies and Their Corresponding Recurrence Rates (Open Table in a new window)

Studies

Recurrence rates

Resnick and O'Connor (1973)

76%

Evans and Texter (1975)

40%

Novick and Stewart (1976)

50%

Peress et al (1977)

54%

Cummings et al (1978)

49%

Schoborg et al (1979)

70%

Faysal and Freiha (1979)

78%

Jardin and Vallencien (1984)

78%

Lindahl et al (1984)

58%

Kaneti (1986)

38%

Dandekar et al (1995)

43%

Holzbeierlein et al (2004)

19%

Kassouf et al (2006)

49%

Knoedler et al (2012)

43%

 

Peress et al noted that preoperative grade is an important prognostic factor in determining the risk of recurrence after partial cystectomy. [34] They studied 61 patients with stage A transitional cell carcinoma and found that 54% of patients with high-grade lesions experienced recurrence after partial cystectomy and eventually died of their disease. Kassouf et al have shown that a higher pathological stage at time of partial cystectomy was associated with shorter recurrence-free survival. Smaldone et al found that only tumor size at time of partial cystectomy was associated with tumor recurrence. [35] Older studies by Resnick and O'Connor and by Faysal and Freiha have also confirmed these findings. [36, 37]

These high local recurrence rates reflect the natural history of bladder cancer. Urothelial carcinoma of the bladder may affect the urothelium globally in some patients. Recurrences and survival outcomes depend on tumor stage and grade. Conservative management of Ta-T2 disease with transurethral resection alone results in a 60% recurrence rate. Those patients with history of previous tumors have an 84% recurrence rate, with nearly half of all tumor recurrences being multifocal. At initial presentation, two thirds of urothelial cancer patients have superficial (Ta, T1) disease, and two thirds of these patients experience recurrence (with 20% of the recurrences being of a higher grade). Death from urothelial carcinoma occurs in 5% of patients with grade 1 disease, 16% of patients with grade II disease, 28-35% of patients with grade III/stage Ta disease, and 83% of patients with grade III/stage T2 disease.

Recurrent local disease may be treated with transurethral resection, intravesical chemotherapy, radiotherapy, repeat partial cystectomy, and radical cystectomy. Of all patients who undergo partial cystectomy as original therapy, 4-15% eventually undergo radical cystectomy. Salvage radical cystectomy may confer prolonged survival, though prognosis is largely related to pathological tumor stage and nodal status. [38]


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