537 Early, intermediate and late recurrence after radical cystectomy due to bladder cancer: The necessity of a tailored follow up

Title

537

Early, intermediate and late recurrence after radical cystectomy due to bladder cancer: The necessity of a tailored follow up Eur Urol Suppl 2015;14/2;e537          

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Moschini M. 1 , Gandaglia G.1 , Cucchiara V. 1 , Luzzago S. 1 , Suardi N.1 , Salonia A. 1 , Karnes J. 2 , Shariat S. 3 , Damiano R.4 , Briganti A. 1 , Montorsi F.1 , Colombo R.1 1 Uri,

Irccs Ospedale San Raffaele, Vita-Salute San Raffaele University, Dept. of Oncology, Dept. of Urology, Milan, Italy, 2 Mayo Clinic,

Dept. of Urology, Rochester, United States of America, 3 Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Dept. of Urology, Vienna, Austria, 4 Magna Graecia University of Catanzaro, Dept. of Urology, Catanzaro, Italy INTRODUCTION & OBJECTIVES: Data about recurrence after radical cystectomy (RC) are scarce, especially considering time and pattern of recurrence. Particularly interesting is the possibility to achieve early, intermediate and late recurrence, considering the fact that the actual follow up schemes did not take in account the possibility to incur in different pattern of recurrence at different time. Under this light we aimed to find different timing for different recurrent in order to offer a more tailored follow up schemes. MATERIAL & METHODS: Overall, 1,250 consecutive BCa patients treated with radical cystectomy (RC) at a single center between January 1990 and August 2013 with available recurrence information were identified. Complete clinical, pathological and follow-up data were available for all the patients. Time of recurrence were defined considering early (within 12 months), intermediate (within 60 months) and late after (60 months).  Recurrence status, time and site of recurrent were available for all patients. Logistic regression analyses were performed in order to assess characteristics related to early, intermediate and late recurrence. RESULTS: With a mean follow up of 106 months (median 95 months), recurrence were recorded for 416 patients during follow up (33.2%). 228 (54.8%) recurrence were recorded within 12 months, 156 (37.5%) after 12 months and within 60 months and 32 (7.7%) after 60 months. The mean time of recurrence was: 17 months for peritoneal recurrence, 23 for bone recurrence, 32 for urethral recurrence, 57 for ureteral recurrence, 17 for node recurrence, 10 for pelvic recurrence, 19 for lung recurrence, 22 for liver recurrence and 19 for cerebral recurrence. Patients are more likeably to experience early recurrence at node (p=0.05), intermediate recurrence at urethral (p=0.02) and brain (p=0.04) and late recurrence at ureteral (p=0.001). Considering timing of recurrence at MVA, patients that experienced recurrence within 12 months not invariably experienced CSM or OM earlier than patients that experienced recurrence later (all p>0.2). CONCLUSIONS: Different follow up schemes should be offered considering the different possibility to achieve recurrence in different site during follow up. The likeability to experience late recurrence at ureteral even after 5 years after RC suggest to the physicians to maintain a careful follow up even after 5 years.

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