TY - JOUR
T1 - Incidence, risk factors and outcomes of urethral recurrence after radical cystectomy for bladder cancer
T2 - A systematic review and meta-analysis
AU - European Association of Urology–Young Academic Urologists Urothelial Carcinoma Working Group (EAU-YAU)
AU - Laukhtina, Ekaterina
AU - Mori, Keiichiro
AU - D`Andrea, David
AU - Moschini, Marco
AU - Abufaraj, Mohammad
AU - Soria, Francesco
AU - Mari, Andrea
AU - Krajewski, Wojciech
AU - Albisinni, Simone
AU - Teoh, Jeremy Yuen Chun
AU - Quhal, Fahad
AU - Sari Motlagh, Reza
AU - Mostafaei, Hadi
AU - Katayama, Satoshi
AU - Grossmann, Nico
AU - Rajwa, Pawel
AU - Enikeev, Dmitry
AU - Zimmermann, Kristin
AU - Fajkovic, Harun
AU - Glybochko, Petr
AU - Shariat, Shahrokh F.
AU - Pradere, Benjamin
N1 - Funding Information:
EL is supported by the EUSP Scholarship of the European Association of Urology (EAU). KM is supported by The Uehara Memorial Foundation. NCG is supported by the Zurich Cancer League.
Publisher Copyright:
© 2021 The Authors
PY - 2021/12
Y1 - 2021/12
N2 - We aimed to conduct a systematic review and meta-analysis assessing the incidence and risk factors of urethral recurrence (UR) as well as summarizing data on survival outcomes in patients with UR after radical cystectomy (RC) for bladder cancer. The MEDLINE and EMBASE databases were searched in February 2021 for studies of patients with UR after RC. Incidence and risk factors of UR were the primary endpoints. The secondary endpoint was survival outcomes in patients who experienced UR. Twenty-one studies, comprising 9,435 patients, were included in the quantitative synthesis. Orthotopic neobladder (ONB) diversion was associated with a decreased probability of UR compared to non-ONB (pooled OR: 0.44, 95% CI: 0.31–0.61, P < 0.001) and male patients had a significantly higher risk of UR compared to female patients (pooled OR: 3.16, 95% CI: 1.83–5.47, P < 0.001). Among risk factors, prostatic urethral or prostatic stromal involvement (pooled HR: 5.44, 95% CI: 3.58–8.26, P < 0.001; pooled HR: 5.90, 95% CI: 1.82–19.17, P = 0.003, respectively) and tumor multifocality (pooled HR: 2.97, 95% CI: 2.05–4.29, P < 0.001) were associated with worse urethral recurrence-free survival. Neither tumor stage (P = 0.63) nor CIS (P = 0.72) were associated with worse urethral recurrence-free survival. Patients with UR had a 5-year CSS that varied from 47% to 63% and an OS - from 40% to 74%; UR did not appear to be related to worse survival outcomes. Male patients treated with non-ONB diversion as well as patients with prostatic involvement and tumor multifocality seem to be at the highest risk of UR after RC. Risk-adjusted standardized surveillance protocols should be developed into clinical practice after RC.
AB - We aimed to conduct a systematic review and meta-analysis assessing the incidence and risk factors of urethral recurrence (UR) as well as summarizing data on survival outcomes in patients with UR after radical cystectomy (RC) for bladder cancer. The MEDLINE and EMBASE databases were searched in February 2021 for studies of patients with UR after RC. Incidence and risk factors of UR were the primary endpoints. The secondary endpoint was survival outcomes in patients who experienced UR. Twenty-one studies, comprising 9,435 patients, were included in the quantitative synthesis. Orthotopic neobladder (ONB) diversion was associated with a decreased probability of UR compared to non-ONB (pooled OR: 0.44, 95% CI: 0.31–0.61, P < 0.001) and male patients had a significantly higher risk of UR compared to female patients (pooled OR: 3.16, 95% CI: 1.83–5.47, P < 0.001). Among risk factors, prostatic urethral or prostatic stromal involvement (pooled HR: 5.44, 95% CI: 3.58–8.26, P < 0.001; pooled HR: 5.90, 95% CI: 1.82–19.17, P = 0.003, respectively) and tumor multifocality (pooled HR: 2.97, 95% CI: 2.05–4.29, P < 0.001) were associated with worse urethral recurrence-free survival. Neither tumor stage (P = 0.63) nor CIS (P = 0.72) were associated with worse urethral recurrence-free survival. Patients with UR had a 5-year CSS that varied from 47% to 63% and an OS - from 40% to 74%; UR did not appear to be related to worse survival outcomes. Male patients treated with non-ONB diversion as well as patients with prostatic involvement and tumor multifocality seem to be at the highest risk of UR after RC. Risk-adjusted standardized surveillance protocols should be developed into clinical practice after RC.
KW - Radical cystectomy
KW - Risk factors
KW - UR, RC
KW - Urethral recurrence
UR - http://www.scopus.com/inward/record.url?scp=85110471569&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85110471569&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2021.06.009
DO - 10.1016/j.urolonc.2021.06.009
M3 - Review article
C2 - 34266740
AN - SCOPUS:85110471569
SN - 1078-1439
VL - 39
SP - 806
EP - 815
JO - Seminars in Urology
JF - Seminars in Urology
IS - 12
ER -
