Patients with pelvic recurrence post-cystectomy have poor prognosis

Patients with pelvic recurrence after radical cystectomy for transitional cell carcinoma have a poor prognosis, even with subsequent therapy, emphasizing the need for optimum local control at the time of initial treatment, according to a study published in The British Journal of Urology International (2008; 101:969–72).

Researchers at the Cleveland Clinic Glickman Urological Institute reviewed a consecutive series of 130 patients who had limited bilateral pelvic lymph node dissection and radical cystectomy between 1987 and 2000 and who later developed pelvic recurrence. All patients were staged N0M0 before cystectomy, and none received neoadjuvant radiotherapy or chemotherapy.

Pelvic recurrence was defined as a radiographic soft-tissue density of ≥2 cm below the bifurcation of the aorta. Median time from cystectomy to pelvic recurrence was 7.3 months (1.2–55.4) months. No patients had concomitant distant metastasis. Of the patients, 61.5% were diagnosed with pelvic recurrence because of symptoms, and 38.5% by surveillance computed tomography. Of the 130 patients, 128 died, with a median survival from the time of recurrence of 4.9 months (0.1–129.3 months).

The median overall survival time for pelvic recurrence diagnosed with CT was 21.6 months versus 10.6 months for symptomatic presentations (p<.001). In the univariate and multivariate models, type of presentation and pT stage were predictors of overall survival, while age and pN status were not, according to the researchers, led by Eric A. Klein, MD.