Oncologic Surveillance for Variant Histology Bladder Cancer after Radical Cystectomy.

Autor:	Martini A; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Afferi L; Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland., Zamboni S; Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.; Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy., Schultz JG; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Lonati C; Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland., Mattei A; Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland., Karnes RJ; Department of Urology, Mayo Clinic, Rochester, Minnesota., Soligo M; Department of Urology, Mayo Clinic, Rochester, Minnesota., Stabile A; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Di Trapani E; Department of Urology, European Institute of Oncology, Milan, Italy., De Cobelli O; Department of Urology, European Institute of Oncology, Milan, Italy.; Department of Oncology and Hematology, University of Milan, Italy., Simone G; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Simeone C; Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy., Alvarez-Maestro M; Department of Urology, Instituto de Investigación Hospital Universitario Louisiana Paz (IdiPAZ), Madrid, Spain., Gandaglia G; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Gallina A; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Colombo R; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Briganti A; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Montorsi F; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Xylinas E; Department of Urology; Bichat Hospital, Paris Descartes University, Paris, France., Shariat SF; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic., Moschini M; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Jazyk:	angličtina
Zdroj:	The Journal of urology [J Urol] 2021 Oct; Vol. 206 (4), pp. 885-893. Date of Electronic Publication: 2021 May 25.
DOI:	10.1097/JU.0000000000001886
Abstrakt:	Purpose: Presently, major guidelines do not provide specific recommendations on oncologic surveillance for patients who harbor variant histology (VH) bladder cancer (BCa) at radical cystectomy. We aimed to create a personalized followup scheme that dynamically weighs other cause mortality (OCM) vs the risk of recurrence for VH BCa, and to compare it with a similar one for pure urothelial carcinoma (pUC). Materials and Methods: Within a multi-institutional registry, 528 and 1,894 patients with VH BCa and pUC, respectively, were identified. The Weibull regression was used to detect the time points after which the risk of OCM exceeded the risk of recurrence during followup. The risk of OCM over time was stratified based on age and comorbidities, and the risk of recurrence on pathological stage and recurrence site. Results: Individuals with VH had a higher risk of recurrence (recurrence-free survival 30% vs 51% at 10 years, p <0.001) and shorter median time to recurrence (88 vs 123 months, p <0.01) relative to pUC. Among VH, micropapillary variant conferred the greatest risk of recurrence on the abdomen and lungs, and mixed variants carried the greatest risk of metastasizing to bones and other sites compared to pUC. Overall, surveillance should be continued for a longer time for individuals with VH BCa. Notably, patients younger than 60 years with VH and pT0/Ta/T1/N0 at radical cystectomy should continue oncologic surveillance after 10 years vs 6.5 years for pUC individuals. Conclusions: VH BCa is associated with greater recurrence risk than pUC. A followup scheme that is valid for pUC should not be applied to individuals with VH. Herein, we present a personalized approach for surveillance that may allow an improved shared decision.
Databáze:	MEDLINE
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