Risk Factors for Urethral Recurrence in Men After Radical Cystectomy with Orthotopic Urinary Diversion for Urothelial Carcinoma: A Retrospective Cohort Study
- 주제(키워드) bladder cancer , neobladder , radical cystectomy , risk factor , urethral recurrence
- 주제(기타) Oncology
- 설명문(일반) [Lee, Dong Hyeon] Ewha Womans Univ, Med Ctr, Dept Urol, Sch Med, Seoul, South Korea; [Song, Wan] Sungkyunkwan Univ, Dept Urol, Samsung Med Ctr, Sch Med, 81 Irwon Ro, Seoul 135710, South Korea
- 등재 SCIE, SCOPUS
- OA유형 gold, Green Published
- 발행기관 DOVE MEDICAL PRESS LTD
- 발행년도 2020
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000172404
- 본문언어 영어
- Published As https://dx.doi.org/10.2147/CMAR.S260979
- PubMed https://pubmed.ncbi.nlm.nih.gov/32848456
초록/요약
Purpose: To evaluate the risk factors affecting urethral recurrence (UR) in men after radical cystectomy (RC) with ileal orthotopic neobladder (IONB). Materials and Methods: We retrospectively reviewed 348 men who underwent RC with IONB for bladder cancer between January 2010 and December 2017. Clinicopathologic characteristics, including tumor location (trigone and/or bladder neck), prostatic urethral and/or stromal involvement, presence of carcinoma in situ (CIS), pathologic T and N stage, and urethral resection margin status, were identified. Kaplan-Meier survival analysis was used to illustrate urethral recurrence-free survival (URFS), and Cox proportional hazard models were applied to identify factors predicting UR. Results: Of the 348 patients, UR was identified in 7 (2.0%) patients during the mean follow-up of 33.3 months. The 2-, 3-, and 5-year URFS rates were 97.6%, 96.3%, and 93.8%, respectively. On multivariable analysis, prostatic urethral involvement (P = 0.033, hazard ratio: 6.25, 95% confidence interval: 1.06-36.96) was an independent predictor of UR. When patients were divided according to prostatic urethral involvement (negative vs positive), the 2- and 3-year URFS rates were significantly different (93.8% and 96.8%, respectively, vs 92.0% and 92.0%, respectively; P = 0.020). All 7 patients with UR underwent transurethral surgery and maintained their IONB. Conclusion: In this series, UR occurred in approximately 2% of men after RC with IONB. Prostatic urethral involvement was the only significant prognostic factor for UR. Follow-up strategies considering UR risk should be adopted to facilitate early detection in those at high risk of UR.
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