MP72-04 IMPACT OF THE SITE OF RECURRENCE AFTER RADICAL CYSTECTOMY ON SURVIVAL: DIFFERENT SITES FOR DIFFERENT OUTCOMES.
INTRODUCTION AND OBJECTIVES
The recurrence of urothelial cancer after radical cystectomy (RC) for bladder cancer (BCa) associates with a reduced survival during follow up. However, data about different patterns of recurrence is limited in literature and the impact of the site of the first recurrence on cancer specific mortality (CSM) still remains to be defined.
METHODS
The study included 1,250 consecutive BCa patients treated with RC at a single tertiary care institution between January 1990 and August 2013. All with recurrence information available. Complete clinical, pathological and follow-up data were available for all the patients. Moreover, status, timing as well as site of first recurrence were available for all patients. Kaplan-Meier curves assessed the time to recurrence and time to survival after first recurrence. Logistic regression analyses were performed in order to assess characteristics related to dead within 3 months and beyond 12 months after first recurrence.
RESULTS
With a mean follow up of 106 months (median: 88), recurrence were recorded for 416 patients (33.2%). Of these, 11 patients experienced brain recurrence (2.6%), 63 liver recurrence (15.1%), 61 nodes recurrence (14.7%), 66 bone recurrence (15.9%), 30 pelvic recurrence (7.2%), 19 peritoneal recurrence (4.6%), 81 lung recurrence (19.5%), 16 ureter recurrence (3.8%), 17 urethral recurrence (4.1%) and 52 (12.5%) patients have unknown site of recurrence. The mean survival after recurrence was 10 months (median, IQR). Specifically brain recurrence has a CSM at 3, 6 and 12 months of 45, 36 and 9%, liver of 74, 53 and 32%, lung of 70, 59 and 34%, bone 82, 51, and 23%, pelvic of 78, 33 and 12%, nodal of 93, 76 and 48%, peritoneal 47%, 27% and 9%, ureteral 92, 83, 72% and urethral 100, 91 and 51%. Patients with peritoneal or brain recurrence had the highest rate of death within 3 months after recurrence (p=0.02 and 0.04 respectively vs. others recurrence). Conversely, patients with nodal and ureteral recurrence had the highest chance of surviving for 12 or more months (p=0.01 and 0.004 respectively vs. others recurrence).
CONCLUSIONS
According to the results of our monocentric series different time to BCa-specific mortality should be expected according to the site of first disease recurrence after RC. This information might be helpful to physicians in order to adopt different therapeutic and palliative strategies for patients according to the site of recurrence.
