title: Outcomes after urothelial recurrence in bladder cancer patients undergoing radical cystectomy.
abstract: OBJECTIVE
  To identify factors prognostic for survival after urothelial recurrence after radical cystectomy for bladder cancer.
  
  
  METHODS
  Of the 2029 patients with bladder cancer who underwent radical cystectomy at our institution, 80 (3.9%) patients 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 factors prognostic for postrecurrence disease-specific (PRDSS) and overall (PROS) survival.
  
  
  RESULTS
  At median follow-up of 12 years, 25 (31.3%) and 55 (68.7%) patients experienced recurrence in the upper tract and urethra, respectively. Median time to recurrence, PRDSS, and PROS were 25.9, 58.4, and 48.7 months, respectively. Older age (P = .018), patients with tumors that were upstaged at cystectomy compared with their clinical stage (P = .049), and positive surgical margins (P = .022) were associated with a lower PROS. The presence of symptoms at follow-up was associated with a poor PRDSS (P = .028), which was confirmed by multivariable analysis. Patients experiencing urothelial recurrence within 2 years of cystectomy had a lower PRDSS (P = .002) and PROS (P = .003), which was confirmed by multivariable analysis. Site of urothelial recurrence did not influence time to recurrence (P = .87), PRDSS (P = .72), or PROS (P = .57).
  
  
  CONCLUSIONS
  Urothelial cancer relapse in the upper urinary tract or urethra has a comparable clinical course, and may be cured with extirpative surgery, with median PROS of 48.7 months after recurrence. Patients experiencing early urothelial recurrence face worse prognosis and should be considered candidates for adjuvant therapy.
authors.affiliation: Department of Pathology and Center for Personalized Medicine, University of Southern California and Norris Comprehensive Cancer Center, Los Angeles, CA.
authors.forename: Anirban P
authors.initials: AP
authors.lastname: Mitra
authors.affiliation: Institute of Urology, University of Southern California and Norris Comprehensive Cancer Center, Los Angeles, CA.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Alemozaffar
authors.affiliation: Institute of Urology, University of Southern California and Norris Comprehensive Cancer Center, Los Angeles, CA.
authors.forename: Brianna N
authors.initials: BN
authors.lastname: Harris
authors.affiliation: Institute of Urology, University of Southern California and Norris Comprehensive Cancer Center, Los Angeles, CA.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Schuckman
authors.affiliation: Department of Urology, Stanford University, Stanford, CA.
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.affiliation: Institute of Urology, University of Southern California and Norris Comprehensive Cancer Center, Los Angeles, CA. Electronic address: daneshma@usc.edu.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D015653:Cystectomy / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods