What are the reported outcomes of radical cystectomy?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Cure rates among patients with stage pT2-pT3b TCC following radical cystectomy are equal or superior to those of any bladder-salvage technique. Despite radical cystectomy, 50% of patients die from their disease (18%-35% of patients with stage pT2). The local recurrence rate among patients with pT3 and pT4 disease is 5%-10% and 15%-25%, respectively.

Mitra et al conducted a study to identify prognostic factors for survival in patients who experienced urothelial recurrence after undergoing radical cystectomy for bladder cancer. [27] Their study cohort consisted of 2029 patients with bladder cancer who underwent radical cystectomy at the University of Southern California Norris Comprehensive Cancer Center, in Los Angeles, California. Of the patients in their cohort, 80 (3.9%) experienced recurrence in the urothelium (upper urinary tract or urethra) and had sufficient follow-up for further analysis. Clinicopathologic characteristics were analyzed by univariate and multivariable analyses to identify prognostic factors for postrecurrence disease-specific and overall survival.

At a median follow-up of 12 years, 25 patients (31.3%) in the study by Mitra and colleagues experienced recurrence in the upper tract, and 55 (68.7%) experienced recurrence in the urethra. Median time to recurrence was 25.9 months. Older age, the presence of tumors that were upstaged at the time of cystectomy, and positive surgical margins were associated with a lower overall survival. The presence of symptoms at follow-up was associated with a poor disease-free survival. Disease-specific survival and overall survival were lower for patients who experienced urothelial recurrence within 2 years of cystectomy. The site of urothelial recurrence did not have a bearing on time to recurrence. The investigators concluded that the clinical course for urothelial cancer relapse in the upper urinary tract is comparable with that in the urethra and that patients experiencing early urothelial recurrence have a worse prognosis and should be considered candidates for adjuvant therapy. [27]

A study by Gondo et al indicated that in patients who undergo radical cystectomy with intestinal urinary diversion, postoperative estimated glomerular filtration rate (eGFR) can be predicted by preoperative eGFR, age, and thickness of abdominal subcutaneous fat tissue. [28]


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