Adherence to post-radical cystectomy (RC) surveillance guidelines may prove to be lifesaving for some patients, according to a poster presentation at the virtual 2021 Genitourinary Cancers Symposium.
Of 3822 patients who underwent RC from 1980-2018, 1100 experienced bladder cancer recurrence over a median 2.4 years. Of these, 789 (71.7%) had symptomatic recurrence and presented with pain (70.2%), constitutional symptoms such as fever or weight loss (50.7%), gastrointestinal symptoms (23.3%), and/or urinary symptoms (23.3%). Another 311 patients (28.3%) had no symptoms and cancer recurrence was detected only during surveillance.
Recurrence was significantly delayed for patients with asymptomatic rather than symptomatic recurrence: median 13.2 vs 10.8 months, Abhinav Khanna, MD, MPH, and collaborators from the Mayo Clinic in Rochester, Minnesota, reported.
During the median 2.4–year follow-up period, 997 patients died, including 840 from bladder cancer. According to the investigators, the group with asymptomatic recurrence had significantly longer cancer-specific survival (median 54.5 vs 27.3 months) and overall survival (median 43.0 vs 25.8 months) compared with the symptomatic recurrence group. In multivariable Cox proportional hazards models, symptomatic recurrence was associated with significant 66% and 48% increased risks of cancer-specific and all-cause mortality, respectively, after adjustment for demographic and clinical factors.
“The subject of whether to perform scheduled cancer surveillance in these patients has been considerably debated over time,” co-investigator Stephen A. Boorjian, MD, of FACS, told Renal & Urology News. “Reported rates of adherence to post-radical cystectomy surveillance guidelines in real-world practice have been as low as 9%, in part reflecting a nihilistic view held by many of the value of routine follow-up.
“We believe that these data support routine follow-up to detect disease recurrence prior to the onset of symptoms if possible,” he continued. “Symptomatic recurrence after RC is associated with worse oncologic outcomes than post-RC recurrence detected by routine surveillance.”
Many factors should be considered for surveillance, including disease stage and patient factors, Dr Boorjian added. “Further study is needed to determine the optimal follow-up regimen balancing patient and disease risks.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Khanna A, Zganjar A, Shah P, et al. Is there value to routine oncologic surveillance after radical cystectomy? Comparative outcomes of symptomatic versus asymptomatic recurrence. Poster presented at the virtual 2021 Genitourinary Cancers Symposium; February 2021. Abstract 421.