The following is a summary of “Recurrence patterns in bladder cancer patients with no residual disease (pT0N0) at radical cystectomy: A 20-year experience” published in the February 2023 issue of Urologic Oncology by Douglawi, et al.

The purpose of this study is to analyze the oncological outcomes and recurrence patterns of patients who underwent radical cystectomy (RC) and had no detectable illness at the time of surgery.

Patients with neoadjuvant chemotherapy (NAC) or transurethral resection (TURBT) alone and no residual disease (pT0N0) were identified by a retrospective assessment of our IRB-approved bladder cancer database between 2000 and 2019. Recurrence-free survival (RFS) was the key measure of success. Factors contributing to recurrence were examined using regression models, and recurrence patterns were described deeply. 234 patients (10.5%) with a median age of 67 were included out of 2222. NAC was performed in 89% of patients, and 62% of patients who underwent TURBT were declared pT0 due to the procedure. 

There were 16 (6.8%) recurrences over a median follow-up of 44 months, with 10 (63%) happening in the ypT0 group. There was no clinical Ta/Tis illness recurrence in any RC patient. The average interval between recurrences was 9 months. 91% (10/11) of recurrences in the ypT0 group occurred within 2 years post cystectomy, while 50% in the pT0 group occurred after 2 years. RFS at 2 and 5 years was lower for patients with ypT0 than those with pT0 (85% and 84% vs. 99% and 95%, respectively; P = 0.003). In addition, 29 patients, or 21%, had a histological variant; the recurrence incidence was greater in this group than in those with pure urothelial carcinoma (12.2% vs. 5.4%, P = 0.02). 

Although extremely uncommon, both groups experienced metastases to the lung and distant organ involvement at comparable rates. Because recurrence and metastasis can occur even 4 years following cystectomy, it is important for patients with pT0N0 pathology at the time of surgery to undergo long-term surveillance. Individuals who reach ypT0 after NAC tend to have a poorer prognosis and a shorter time until recurrence. Thus they may benefit from greater monitoring.

Source: sciencedirect.com/science/article/abs/pii/S1078143922003477