Upper urinary tract and urethral recurrences following radical cystectomy: review of risk factors and outcomes between centres with different follow-up protocols.
OBJECTIVE
To examine which patient-related and tumour-related characteristics predict upper urinary tract recurrence (UUTR) and urethral recurrence (UR) of bladder cancer post-radical cystectomy (RC). Secondary objective is to evaluate whether or not recurrence patterns are similar between two centres with different post-RC follow-up (F/U) protocols.


METHODS
A retrospective cohort study of 574 consecutive patients undergoing radical cystectomy for urothelial carcinoma of the bladder at two tertiary centres was performed. Clinicopathological factors associated with bladder cancer recurrence and patient-related outcomes, including time to recurrence and death, were collected. Risk factors for recurrences were examined using univariate and multivariable regression analyses. Likelihood of recurrence, time to recurrence, and survival were compared.


RESULTS
There was a 3.7 % risk of UUTR (21/574) and a 3.6 % risk of UR (18/503) for the combined cohort at a median F/U of 45 months. When controlling for the effects of all variables modelled, female gender was a significant risk factor for UUT recurrence (OR 3.2, 95 % CI 1.0-9.5, p = 0.03) and prostatic urethral involvement was a significant risk factor for urethral recurrence (OR 7.8, 95 % CI 2.2-27.6, p = 0.001). UUTR were similar (p = 0.82) between Turku (8/205) and Toronto (12/369). Urethral recurrences trended (p = 0.06) towards being more common in Turku (9/151, 6.0 %) versus Toronto (9/352, 2.6 %), but no difference in overall survival was demonstrated between sites.


CONCLUSIONS
The frequency of UUT and urethral recurrences post-cystectomy is relatively low and remained stable for the past 15 years. The ideal F/U protocol to maximize patient-survival remains unknown.
Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada.
Nathan
N
Perlis
Polat
P
Turker
Peter J
PJ
Bostrom
Cynthia
C
Kuk
Tuomas
T
Mirtti
Girish
G
Kulkarni
Neil E
NE
Fleshner
Michael A S
MA
Jewett
Antonio
A
Finelli
Alexandre R
AR
Zlotta
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D002985:Clinical Protocols; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000556:secondary*; D007682:Kidney Pelvis; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010388:Pelvis; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000556:secondary*; D014523:Urethral Neoplasms / Q000401:mortality / Q000556:secondary*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery