Longitudinal Risk of Upper Tract Recurrence Following Radical Cystectomy for Urothelial Cancer and the Potential Implications for Long-Term Surveillance

William Tran, Angel M. Serio, Ganesh V. Raj, Guido Dalbagni, Andrew J. Vickers, Bernard H. Bochner, Harry Herr, S. Machele Donat

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Purpose: The defined risk of upper tract recurrence in published series ranges from 2% to 6%, with most recurrence reported within 2 to 3 years of surgery. However, these recurrence rates are based on statistical methodology that does not take censoring into account. We used landmark time analysis to determine whether the risk of upper tract recurrence changes over time. Materials and Methods: We present a retrospective institutional review board approved review of 1,329 patients who underwent radical cystectomy from 1990 to 2004. Upper tract recurrence was defined as any radiographic, endoscopic or pathologically proven recurrence in the kidney or ureter. Cumulative incidence of upper tract recurrence was estimated by accounting for death without recurrence as a competing risk. Landmark analyses were used to estimate the probability of upper tract recurrence within the next 3 years if recurrence-free at various times after surgery. Results: A total of 80 patients experienced upper tract recurrence. Median followup for patients alive and recurrence-free was 38 months. The 3 and 5-year cumulative incidence of upper tract recurrence was 4% (95% CI 3, 6) and 7% (95% CI 5, 8), respectively. Landmark time analysis showed the 3-year cumulative incidence of upper tract recurrence remained 4% to 6% even at 4 years after radical cystectomy. Any ureteral involvement at radical cystectomy (including carcinoma in situ) portends a significantly higher risk of upper tract recurrence. Conclusions: The incidence for upper tract recurrence was 4% at 3 years and 7% at 5 years. However, the 3-year risk of upper tract recurrence remained around 4% to 6% at any point measured up to 4 years after radical cystectomy and, therefore, did not change over time. This indicates the critical importance of long-term vigilance for upper tract recurrence following radical cystectomy.

Original languageEnglish (US)
Pages (from-to)96-100
Number of pages5
JournalJournal of Urology
Volume179
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Cystectomy
Recurrence
Neoplasms
Incidence
Research Ethics Committees
Carcinoma in Situ
Ureter

Keywords

  • cystectomy
  • recurrence
  • risk
  • urinary bladder neoplasms
  • urinary tract

ASJC Scopus subject areas

  • Urology

Cite this

Longitudinal Risk of Upper Tract Recurrence Following Radical Cystectomy for Urothelial Cancer and the Potential Implications for Long-Term Surveillance. / Tran, William; Serio, Angel M.; Raj, Ganesh V.; Dalbagni, Guido; Vickers, Andrew J.; Bochner, Bernard H.; Herr, Harry; Donat, S. Machele.

In: Journal of Urology, Vol. 179, No. 1, 01.2008, p. 96-100.

Research output: Contribution to journalArticle

Tran, William ; Serio, Angel M. ; Raj, Ganesh V. ; Dalbagni, Guido ; Vickers, Andrew J. ; Bochner, Bernard H. ; Herr, Harry ; Donat, S. Machele. / Longitudinal Risk of Upper Tract Recurrence Following Radical Cystectomy for Urothelial Cancer and the Potential Implications for Long-Term Surveillance. In: Journal of Urology. 2008 ; Vol. 179, No. 1. pp. 96-100.
@article{8b7c613669b843548e30c686b4fe60cc,
title = "Longitudinal Risk of Upper Tract Recurrence Following Radical Cystectomy for Urothelial Cancer and the Potential Implications for Long-Term Surveillance",
abstract = "Purpose: The defined risk of upper tract recurrence in published series ranges from 2{\%} to 6{\%}, with most recurrence reported within 2 to 3 years of surgery. However, these recurrence rates are based on statistical methodology that does not take censoring into account. We used landmark time analysis to determine whether the risk of upper tract recurrence changes over time. Materials and Methods: We present a retrospective institutional review board approved review of 1,329 patients who underwent radical cystectomy from 1990 to 2004. Upper tract recurrence was defined as any radiographic, endoscopic or pathologically proven recurrence in the kidney or ureter. Cumulative incidence of upper tract recurrence was estimated by accounting for death without recurrence as a competing risk. Landmark analyses were used to estimate the probability of upper tract recurrence within the next 3 years if recurrence-free at various times after surgery. Results: A total of 80 patients experienced upper tract recurrence. Median followup for patients alive and recurrence-free was 38 months. The 3 and 5-year cumulative incidence of upper tract recurrence was 4{\%} (95{\%} CI 3, 6) and 7{\%} (95{\%} CI 5, 8), respectively. Landmark time analysis showed the 3-year cumulative incidence of upper tract recurrence remained 4{\%} to 6{\%} even at 4 years after radical cystectomy. Any ureteral involvement at radical cystectomy (including carcinoma in situ) portends a significantly higher risk of upper tract recurrence. Conclusions: The incidence for upper tract recurrence was 4{\%} at 3 years and 7{\%} at 5 years. However, the 3-year risk of upper tract recurrence remained around 4{\%} to 6{\%} at any point measured up to 4 years after radical cystectomy and, therefore, did not change over time. This indicates the critical importance of long-term vigilance for upper tract recurrence following radical cystectomy.",
keywords = "cystectomy, recurrence, risk, urinary bladder neoplasms, urinary tract",
author = "William Tran and Serio, {Angel M.} and Raj, {Ganesh V.} and Guido Dalbagni and Vickers, {Andrew J.} and Bochner, {Bernard H.} and Harry Herr and Donat, {S. Machele}",
year = "2008",
month = "1",
doi = "10.1016/j.juro.2007.08.131",
language = "English (US)",
volume = "179",
pages = "96--100",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Longitudinal Risk of Upper Tract Recurrence Following Radical Cystectomy for Urothelial Cancer and the Potential Implications for Long-Term Surveillance

AU - Tran, William

AU - Serio, Angel M.

AU - Raj, Ganesh V.

AU - Dalbagni, Guido

AU - Vickers, Andrew J.

AU - Bochner, Bernard H.

AU - Herr, Harry

AU - Donat, S. Machele

PY - 2008/1

Y1 - 2008/1

N2 - Purpose: The defined risk of upper tract recurrence in published series ranges from 2% to 6%, with most recurrence reported within 2 to 3 years of surgery. However, these recurrence rates are based on statistical methodology that does not take censoring into account. We used landmark time analysis to determine whether the risk of upper tract recurrence changes over time. Materials and Methods: We present a retrospective institutional review board approved review of 1,329 patients who underwent radical cystectomy from 1990 to 2004. Upper tract recurrence was defined as any radiographic, endoscopic or pathologically proven recurrence in the kidney or ureter. Cumulative incidence of upper tract recurrence was estimated by accounting for death without recurrence as a competing risk. Landmark analyses were used to estimate the probability of upper tract recurrence within the next 3 years if recurrence-free at various times after surgery. Results: A total of 80 patients experienced upper tract recurrence. Median followup for patients alive and recurrence-free was 38 months. The 3 and 5-year cumulative incidence of upper tract recurrence was 4% (95% CI 3, 6) and 7% (95% CI 5, 8), respectively. Landmark time analysis showed the 3-year cumulative incidence of upper tract recurrence remained 4% to 6% even at 4 years after radical cystectomy. Any ureteral involvement at radical cystectomy (including carcinoma in situ) portends a significantly higher risk of upper tract recurrence. Conclusions: The incidence for upper tract recurrence was 4% at 3 years and 7% at 5 years. However, the 3-year risk of upper tract recurrence remained around 4% to 6% at any point measured up to 4 years after radical cystectomy and, therefore, did not change over time. This indicates the critical importance of long-term vigilance for upper tract recurrence following radical cystectomy.

AB - Purpose: The defined risk of upper tract recurrence in published series ranges from 2% to 6%, with most recurrence reported within 2 to 3 years of surgery. However, these recurrence rates are based on statistical methodology that does not take censoring into account. We used landmark time analysis to determine whether the risk of upper tract recurrence changes over time. Materials and Methods: We present a retrospective institutional review board approved review of 1,329 patients who underwent radical cystectomy from 1990 to 2004. Upper tract recurrence was defined as any radiographic, endoscopic or pathologically proven recurrence in the kidney or ureter. Cumulative incidence of upper tract recurrence was estimated by accounting for death without recurrence as a competing risk. Landmark analyses were used to estimate the probability of upper tract recurrence within the next 3 years if recurrence-free at various times after surgery. Results: A total of 80 patients experienced upper tract recurrence. Median followup for patients alive and recurrence-free was 38 months. The 3 and 5-year cumulative incidence of upper tract recurrence was 4% (95% CI 3, 6) and 7% (95% CI 5, 8), respectively. Landmark time analysis showed the 3-year cumulative incidence of upper tract recurrence remained 4% to 6% even at 4 years after radical cystectomy. Any ureteral involvement at radical cystectomy (including carcinoma in situ) portends a significantly higher risk of upper tract recurrence. Conclusions: The incidence for upper tract recurrence was 4% at 3 years and 7% at 5 years. However, the 3-year risk of upper tract recurrence remained around 4% to 6% at any point measured up to 4 years after radical cystectomy and, therefore, did not change over time. This indicates the critical importance of long-term vigilance for upper tract recurrence following radical cystectomy.

KW - cystectomy

KW - recurrence

KW - risk

KW - urinary bladder neoplasms

KW - urinary tract

UR - http://www.scopus.com/inward/record.url?scp=36749005166&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=36749005166&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2007.08.131

DO - 10.1016/j.juro.2007.08.131

M3 - Article

C2 - 17997449

AN - SCOPUS:36749005166

VL - 179

SP - 96

EP - 100

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 1

ER -