Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study.
Bladder cancer
Radical cystectomy
Urethral recurrence
Urethrectomy
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
received:
14
02
2022
accepted:
13
04
2022
pubmed:
21
5
2022
medline:
30
6
2022
entrez:
20
5
2022
Statut:
ppublish
Résumé
The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB). We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement). A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04). In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients' history may allow for better clinical decision-making and patient counseling.
Identifiants
pubmed: 35596017
doi: 10.1007/s00345-022-04025-z
pii: 10.1007/s00345-022-04025-z
pmc: PMC9236994
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1689-1696Informations de copyright
© 2022. The Author(s).
Références
Gakis G et al (2017) Systematic review on the fate of the remnant urothelium after radical cystectomy. Eur Urol. https://doi.org/10.1016/j.eururo.2016.09.035
doi: 10.1016/j.eururo.2016.09.035
pubmed: 27916203
Chang SS et al (2020) Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guidelines (amended 2020). J Urol. https://doi.org/10.1016/j.juro.2017.04.086
doi: 10.1016/j.juro.2017.04.086
pubmed: 33356478
pmcid: 8112465
Laukhtina E et al (2021) Incidence, risk factors and outcomes of urethral recurrence after radical cystectomy for bladder cancer : a systematic review and meta-analysis. Urol Oncol Semin Orig Investig 39:806–815. https://doi.org/10.1016/j.urolonc.2021.06.009
doi: 10.1016/j.urolonc.2021.06.009
Witjes JA et al (2020) EAU-ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multistakeholder effort† [formula presented]: under the auspices of the EAU-ESMO guidelines committees. Eur Urol. https://doi.org/10.1016/j.eururo.2019.09.035
doi: 10.1016/j.eururo.2019.09.035
pubmed: 32978014
pmcid: 7183974
Witjes JA et al (2022) EAU guidelines on muscle-invasive and metastatic bladder cancer. In: EAU guidelines. 2022
Spiess PE et al (2006) Immediate versus staged urethrectomy in patients at high risk of urethral recurrence: is there a benefit to either approach? Urology 67(3):466–471. https://doi.org/10.1016/j.urology.2005.09.043
doi: 10.1016/j.urology.2005.09.043
pubmed: 16527559
Hakozaki K et al (2021) Significance of prophylactic urethrectomy at the time of radical cystectomy for bladder cancer. Jpn J Clin Oncol 51(2):287–295. https://doi.org/10.1093/jjco/hyaa168
doi: 10.1093/jjco/hyaa168
pubmed: 32893303
Nelles JL, Konety BR, Saigal C, Pace J, Lai J (2008) Urethrectomy following cystectomy for bladder cancer in men: practice patterns and impact on survival. J Urol 180(5):1933–1937. https://doi.org/10.1016/j.juro.2008.07.039
doi: 10.1016/j.juro.2008.07.039
pubmed: 18801516
pmcid: 2643351
Shariat SF et al (2007) Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ-confined TCC at radical cystectomy. Eur Urol 51(1):152–160. https://doi.org/10.1016/j.eururo.2006.08.037
doi: 10.1016/j.eururo.2006.08.037
pubmed: 17011114
Novara G et al (2010) Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients. J Urol 183(6):2165–2170. https://doi.org/10.1016/j.juro.2010.02.021
doi: 10.1016/j.juro.2010.02.021
pubmed: 20399473
Rink M et al (2012) Death certificates are valid for the determination of cause of death in patients with upper and lower tract urothelial carcinoma. Eur Urol. https://doi.org/10.1016/j.eururo.2011.12.055
doi: 10.1016/j.eururo.2011.12.055
pubmed: 23273681
pmcid: 4378834
Li X, Wang W, Zhu G, He W, Gou X (2018) Risk factors, follow-up, and treatment of urethral recurrence following radical cystectomy and urinary diversion for bladder cancer : a meta-analysis of 9498 patients. Oncotarget 9(2):2782–2796
doi: 10.18632/oncotarget.23451
Coutts A, Grigor K, Fowler J (1985) Urethral dysplasia and bladder cancer in cystectomy specimens. Br J Urol 57(5):535–541. https://doi.org/10.1111/j.1464-410X.1985.tb05862.x
doi: 10.1111/j.1464-410X.1985.tb05862.x
pubmed: 4063735
Elshal AM, Barakat TS, Mosbah A, Abdel-Latif M, Abol-Enein H (2011) Complications of radical cysto-urethrectomy using modified Clavien grading system: prepubis versus perineal urethrectomy. BJU Int 108(8):1297–1300. https://doi.org/10.1111/j.1464-410X.2010.09987.x
doi: 10.1111/j.1464-410X.2010.09987.x
pubmed: 21352465
Joniau S, Shabana W, Verlinde B, Van Poppel H (2007) Prepubic urethrectomy during radical cystoprostatectomy. Eur Urol 51(4):915–921. https://doi.org/10.1016/j.eururo.2006.09.046
doi: 10.1016/j.eururo.2006.09.046
pubmed: 17069962
Labbate C, Werntz RP, Adamic B, Steinberg GD (2019) The impact of omission of intraoperative frozen section prior to orthotopic neobladder reconstruction. J Urol 202(4):763–768. https://doi.org/10.1097/JU.0000000000000317
doi: 10.1097/JU.0000000000000317
pubmed: 31059666
Laukhtina E et al (2021) Accuracy of frozen section analysis of urethral and ureteral margins during radical cystectomy for bladder cancer: a systematic review and diagnostic meta-analysis. Eur Urol Focus. https://doi.org/10.1016/j.euf.2021.05.010
doi: 10.1016/j.euf.2021.05.010
pubmed: 34563481
Stein J, Penson D, Wu S, Skinner D (2007) Pathological guidelines for orthotopic urinary diversion in women with bladder cancer: a review of the literature. J Urol 178(3):756–760. https://doi.org/10.1016/j.juro.2007.05.013
doi: 10.1016/j.juro.2007.05.013
pubmed: 17631333
Nieder AM, Sved PD, Gomez P, Kim SS, Manoharan M, Soloway MS (2004) Urethral recurrence after cystoprostatectomy: implications for urinary diversion and monitoring. Urology. https://doi.org/10.1016/j.urology.2004.06.012
doi: 10.1016/j.urology.2004.06.012
pubmed: 15533484