title: Outcome of Muscle-Invasive Urothelial Bladder Cancer After Radical Cystectomy.
abstract: We aimed at clarification of reasons for recurrence of urothelial carcinoma after radical cystectomy in a retrospective study that included 189 patients. Presence of lymphovascular invasion even in node-negative cases, high tumor grade, and high nodal stage appeared to be independent predictors for recurrence. This raises the necessity for postoperative multimodality treatment to improve disease-free survival.
  
  
  BACKGROUND
  Radical cystectomy remains the gold standard for local control of muscle-invasive bladder cancer. Despite that, a significant proportion of patients develop disease recurrence. Several predictors for recurrence have been described and the implication of such factors on development of recurrence will help in modification of treatment strategies to improve the prognosis of bladder cancer patients.
  
  
  METHODS
  This is a retrospective study carried on patients with muscle-invasive urothelial carcinoma who underwent radical cystectomy at the National Cancer Institute in 3 years; January 2007 to December 2009, and analyzed for the development of recurrence and potential risk factors.
  
  
  RESULTS
  The 3-year disease-free survival (DFS) rate was 56%. Seventy patients (37%) developed disease recurrence during the follow-up period. Of these recurrences, 17 patients (24.3%) developed local and/or regional recurrences, 45 patients (64.3%) developed distant metastasis, and 8 patients (11.4%) developed local and/or regional and distant recurrences. In univariate analysis, lymph node metastasis (P < .001), lymphovascular invasion (LVI) (P < .001), high grade (P = .005), and advanced tumor stage (P = .002) were significantly associated with development of recurrence. In multivariate analysis, lymph node metastasis, LVI, and high grade were significantly associated with tumor recurrence and poor DFS.
  
  
  CONCLUSIONS
  Lymph node metastasis, LVI, and high tumor grade were independent prognostic factors that affected tumor recurrence and DFS. LVI status should be reported in radical cystectomy specimens to help in risk assessment of patients especially in node-negative cases.
authors.affiliation: Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt. Electronic address: asmaa.salama@nci.cu.edu.eg.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Salama
authors.affiliation: Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Abdelmaksoud M
authors.initials: AM
authors.lastname: Abdelmaksoud
authors.affiliation: Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Shawki
authors.affiliation: Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Abdelbary
authors.affiliation: Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Hatem
authors.initials: H
authors.lastname: Aboulkassem
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Outcome; Radical cystectomy; Recurrence; Survival; Urothelial carcinoma