The following is a summary of “Competing mortality risk from second primary malignancy in bladder cancer patients following radical cystectomy: Implications for survivorship,” published in the February 2023 issue of Urologic Oncology by Hensley et al.

Muscle-invasive bladder cancer (BC) is linked to the highest rate of second nonurothelial cancers (SNUC) of all solid malignancies and is frequently diagnosed in individuals with overlapping mortality hazards. Researchers examined the prevalence, causes, and timing of SNUC as an alternative risk factor for mortality in patients with BC who underwent radical cystectomy (RC). This retrospective cohort analysis analyzed data from patients who had RC for cT2-4 N0M0 BC at a single, high-volume, tertiary care referral hospital between January 1, 2005, and December 31, 2018. Predictive factors for SNUC were analyzed using a multivariate regression model based on the Fine-Gray method. Using a variant of the Kaplan-Meier method, researchers calculated the cumulative incidence of mortality (CIM).

About 693 patients had a median follow-up of 3.7 years (interquartile range [IQR] 1.9–5.9 years). A total of 85 patients, or 12.3%, developed SNUC at a median time post-RC of 3.0 years (IQR 1.2–5.5 years). Freedom from BC recurrence or metastasis was the only significant predictor of SNUC on multivariable analysis (HR 1.54, 95% CI 1.12-1.76, P = 0.019). Primary lung cancer accounted for 24 (3.2% of the cohort), and colon cancer accounted for 9 (1.3%) SNUCs. Imaging for BC monitoring identified SNUC in 35/52 (67.3%) individuals with solid-organ visceral primary tumors. A total of 38.8% of those diagnosed with SNUC died; among the most fatal cancers were pancreatic (62.5%), lung (54.2%), and colon (44.4%). After 12 years post-RC, the cumulative incidence of SNUC was 22.1% (95% CI, 16.8-27.9%), and this rose steadily over time. 

As many as 163 patients (23.5% of the total) passed away as a result of BC, while another 33 (4.8%) passed away as a result of SNUC, and another 94 (13.6%) passed away from some other cause. When comparing the CIM for BC before and after RC, researchers found that the CIM for BC stabilizes around 24% about 5 years post-RC, but the incidence of other-cause death steadily increases. CIM for BC was 27.2% (95% CI: 23.5-31%) and CIM for all other causes was 20.0% (95% CI: 15.8-24.6%) by post-RC year 9.

Source: sciencedirect.com/science/article/abs/pii/S1078143922003933