Surveillance guidelines based on recurrence patterns after radical cystectomy for bladder cancer
Wednesday, 18 April 2012- Radical cystectomy with pelvic lymph node dissection is recognized as the standard of care for carcinoma invading bladder muscle and for refractory non-muscle-invasive bladder cancer.
Owing to high recurrence and progression rates, a two-pronged strict surveillance regimen, consisting of both functional and oncological follow-up, has been advocated. It is also well recognized that more aggressive tumours with extravesical disease and node-positive disease recur more frequently and have worse outcomes.
F. Yafi and colleagues conducted a study which adds to the scant body of literature available regarding surveillance strategies after radical cystectomy for bladder cancer. In a report published in a recent online edition of BJU International, the authors wrote that in the absence of any solid evidence supporting the role of strict surveillance regimens, this extensive examination of recurrence patterns in a large multi-institutional project lends further support to the continued use of risk-stratified follow-up, and emphasizes the need for earlier strict surveillance in patients with extravesical and node-positive disease.
The authors said they aimed to review their data on recurrence patterns after radical cystectomy (RC) for bladder cancer (BC), and to establish appropriate surveillance protocols.
The researchers collected and pooled data from a database of 2287 patients who had undergone RC for BC between 1998 and 2008 in eight different Canadian academic centres. Of the 2287 patients, 1890 had complete recurrence information and form the basis of the present study.
A total of 825 patients (43.6%) developed recurrence. According to location, 48.6% of recurrent tumours were distant, 25.2% pelvic, 14.5% retroperitoneal and 11.8% to multiple regions such as pelvic and retroperitoneal or pelvic and distant.
The median (range) time to recurrence for the entire population was 10.1 (1–192) months with 90 and 97% of all recurrences within 2 and 5 years of RC, respectively. According to stage, pTxN+ tumours were more likely to recur than ≥pT3N0 tumours and ≤pT2N0 tumours (5-yr RFS 25% vs. 44% vs. 66% respectively, P < 0.001). Similarly, pTxN+ tumours had a shorter median time to recurrence (9 months, range 1–72 months) than ≥pT3N0 tumours (10 months, range 1–70 months) or ≤pT2N0 tumours (14 months, range 1–192 months, P < 0.001).
“Differences in recurrence patterns after RC suggest the need for varied follow-up protocols for each group,” the authors concluded. “We propose a stage-based protocol for surveillance of patients with BC treated with RC that captures most recurrences while limiting over-investigation.”
Source: F. Yafi, et al., “Surveillance guidelines based on recurrence patterns after radical cystectomy for bladder cancer: the Canadian Bladder Cancer Network experience,” BJU International, DOI: 10.1111/j.1464-410X.2012.11133.x