The predictors of local recurrence after radical cystectomy in patients with invasive bladder cancer.
OBJECTIVE
To examine the association between local recurrence and distant metastasis or disease-specific survival and identify independent factor predictors for local recurrence.


METHODS
We identified a study population of 146 consecutive patients treated surgically for invasive bladder cancer at our institution between 1987 and 2003. We clarified the relationship among local recurrence, distant metastasis and disease-specific survival and identified significant predictors for local recurrence.


RESULTS
Local recurrence developed in 26 (17.8%) of the 146 patients at a median of 10 months (range, 1-73 months) after cystectomy. It was independently associated with distant metastasis in addition to the number of retrieved lymph nodes. The 2- and 5-year metastasis-free rates were 86.7 and 76.5% in patients without local recurrence and 26.5 and 0% in those with local recurrence (P < 0.001), respectively. The presence or absence of local recurrence and tumor grade were independent predictors of disease-specific survival. The 2- and 5-year disease-specific survival rates were 93.5 and 88.3% in patients without local recurrence and 55.1 and 35.4% in those with local recurrence (P < 0.001). The presence of concomitant adenocarcinoma component, pathological nodal involvement and the number of retrieved lymph nodes were independent predictors of local recurrence.


CONCLUSIONS
Local recurrence was independently associated with distant metastasis and disease-specific survival. Patients who have the predictive factors described above may benefit from integrated surgical therapies with post-operative adjuvant chemotherapy.
Ide
Hiroki
H
Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Kikuchi
Eiji
E
Miyajima
Akira
A
Nakagawa
Ken
K
Ohigashi
Takashi
T
Nakashima
Jun
J
Oya
Mototsugu
M
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002277:Carcinoma / Q000556:secondary* / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D019043:Vascular Neoplasms / Q000556:secondary