SURVEILLANCE AFTER RADICAL CYSTECTOMY IMPROVES SURVIVAL

NEW YORK (Reuters Health) Jul 02 - Patients who've had radical cystectomy for transitional cell carcinoma have better survival with regular surveillance, Swiss researchers report.

Dr. Urs E. Studer and colleagues at the University of Berne used what they call a "risk-oriented protocol" to follow patients who had surgery for localized cancer, with no adjuvant chemotherapy or radiation.

The protocol incorporated oncologic, functional, and metabolic studies, with variations once patients were five years out from surgery (e.g., IV urography was no longer performed after that point).

In particular, Dr. Studer told Reuters Health by e-mail, "Regular urethral wash-out cytology turned out to be very instrumental. This allowed us to detect urethral carcinoma in situ at an early stage and to treat it conservatively with BCG-perfusions and to avoid urethrectomies."

Overall, out of 479 patients, 174 (36.3%) had recurrence during a median of 4.3 years, with exactly half of those diagnosed on routine follow-up. (The other patients had become symptomatic, according to the June 4th online report in European Urology.)

Lung metastases and urethral recurrences were generally diagnosed at follow-up. Symptoms were predominantly the result of bone metastases and concomitant pelvic and distant recurrences.

The cumulative 5-year cancer-specific survival rate for the entire cohort was 69.8%. Overall survival was 61.9%. Of the 174 patients with recurrence, 144 died from bladder cancer and 8 from other causes. Twenty-two patients with recurrence were still alive at last follow-up.

Patients whose disease progression was picked up during routine exams had a slight but significant survival advantage, with a hazard ratio of 0.65 for cancer-specific survival and 0.66 for overall survival.

On multivariate analysis, the only significant predictors of these outcomes were the mode of recurrence diagnosis and site of initial recurrence.

Dr. Studer and colleagues say their follow-up scheme might not have been optimal. "A higher diagnostic yield and better survival could perhaps be achieved by intensifying CT exams, anticipating bone scans, (and) replacing chest x-ray with CT scans and intravenous urography with CT urography," they write.

The authors also acknowledge that the possible benefits of close surveillance "must be weighed against (the) higher costs and radiation-induced toxicity."

http://link.reuters.com/myr55m

Eur Urol 2010.