Oncologic, Perioperative Outcomes of Female Radical Cystectomy: Results from a Multicenter Study in Korea
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Purpose The lower incidence of bladder cancer among women has led to a lack of information on female radical cystectomy (RC). This study aimed to analyze the characteristics related with female RC in a cohort from multiple academic institutions. Materials and Methods This was a retrospective review of 384 female patients who underwent RC for bladder cancer. Epidemiologic, perioperative variables including urologic referral period with consequent pathologic stage distributions were assessed. The changes in surgical techniques over time were illustrated. Also, we evaluated recurrence-free survival (RFS) at 2 and 5 years and overall survival (OS) at 5 years with stage-specific analyses using the Kaplan-Meier method. Results The mean follow-up time was 35 months (interquartile rage [IQR], 9 to 55). The average time to urologic referral with initial symptoms was 5.5 (IQR, 1 to 6) months and over 20% of patients visited clinics after 6 months. In subsequent stage distributions according to referral period, T2 or higher stage distributions were abruptly increased after 1 year. Overall 2-year/5-year RFS rates were 0.72/0.57 and 5-year OS was 0.61. Notable surgical descriptions were as follows: 91% of patients underwent open RC; 80% of patients underwent an ileal conduit; and 83% of patients received anterior exenteration. However, the proportions of robotic surgery, orthotopic neobladder and organ sparing cystectomy have increased recently. Conclusion We identified the general characteristics and changes in pattern of female RC. Our results also suggest that women are susceptible to delays in referral to an urologist and are at greater risk for worse prognosis.
Abstract
Purpose The lower incidence of bladder cancer among women has led to a lack of information on female radical cystectomy (RC). This study aimed to analyze the characteristics related with female RC in a cohort from multiple academic institutions. Materials and Methods This was a retrospective review of 384 female patients who underwent RC for bladder cancer. Epidemiologic, perioperative variables including urologic referral period with consequent pathologic stage distributions were assessed. The changes in surgical techniques over time were illustrated. Also, we evaluated recurrence-free survival (RFS) at 2 and 5 years and overall survival (OS) at 5 years with stage-specific analyses using the Kaplan-Meier method. Results The mean follow-up time was 35 months (interquartile rage [IQR], 9 to 55). The average time to urologic referral with initial symptoms was 5.5 (IQR, 1 to 6) months and over 20% of patients visited clinics after 6 months. In subsequent stage distributions according to referral period, T2 or higher stage distributions were abruptly increased after 1 year. Overall 2-year/5-year RFS rates were 0.72/0.57 and 5-year OS was 0.61. Notable surgical descriptions were as follows: 91% of patients underwent open RC; 80% of patients underwent an ileal conduit; and 83% of patients received anterior exenteration. However, the proportions of robotic surgery, orthotopic neobladder and organ sparing cystectomy have increased recently. Conclusion We identified the general characteristics and changes in pattern of female RC. Our results also suggest that women are susceptible to delays in referral to an urologist and are at greater risk for worse prognosis.
참고문헌 (30)
- Cheng L, "Predicting the survival of bladder carcinoma patients treated with radical cystectomy", Cancer, 88, pp.2326~2332 (2000)
- Messer JC, "Female gender is associated with a worse survival after radical cystectomy for urothelial carcinoma of the bladder : a competing risk analysis", Urology, 83, pp.863~867 (2014)
- Fajkovic H, "Impact of gender on bladder cancer incidence, staging, and prognosis", World J Urol, 29, pp.457~463 (2011)
- Herkommer K, "Gender and body mass index as risk factors for bladder perforation during primary transurethral resection of bladder tumors", J Urol, 187, pp.1566~1570 (2012)
- Kluth LA, "Female gender is associated with higher risk of disease recurrence in patients with primary T1 high-grade urothelial carcinoma of the bladder", World J Urol, 31, pp.1029~1036 (2013)
- van der Poel HG, "The reproducibility of cytomorphometrical grading of bladder tumours", Virchows Arch A Pathol Anat Histopathol, 416, pp.521~525 (1990)
- Johnson EK, "Patterns of hematuria referral to urologists: does a gender disparity exist?", Urology, 72, pp.498~502 (2008)
- Bhatta Dhar N, "Nerve-sparing radical cystectomy and orthotopic bladder replacement in female patients", Eur Urol, 52, pp.1006~1014 (2007)
- Ali-El-Dein B, "Preservation of the internal genital organs during radical cystectomy in selected women with bladder cancer : a report on 15 cases with long term follow-up", Eur J Surg Oncol, 39, pp.358~364 (2013)
- Gakis G, "ICUD-EAU International Consultation on Bladder Cancer 2012 : Radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder", Eur Urol, 63, pp.45~57 (2013)
- Stein JP, "Radical cystectomy in the treatment of invasive bladder cancer : long-term results in 1, 054 patients", J Clin Oncol, 19, pp.666~675 (2001)
- Madersbacher S, "Radical cystectomy for bladder cancer today : a homogeneous series without neoadjuvant therapy", J Clin Oncol, 21, pp.690~696 (2003)
- Hautmann RE, "Cystectomy for transitional cell carcinoma of the bladder : results of a surgery only series in the neobladder era", J Urol, 176, pp.486~492 (2006)
- Herr HW, "Surgical factors influence bladder cancer outcomes : a cooperative group report", J Clin Oncol, 22, pp.2781~2789 (2004)
- Nguyen DP, "Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer", Eur Urol, 68, pp.399~405 (2015)
- Mungan NA, "Gender differences in stage-adjusted bladder cancer survival", Urology, 55, pp.876~880 (2000)
- Granberg CF, "Functional and oncological outcomes after orthotopic neobladder reconstruction in women", BJU Int, 102, pp.1551~1555 (2008)
- Ali-El-Dein B, "Oncological outcome after radical cystectomy and orthotopic bladder substitution in women", Eur J Surg Oncol, 35, pp.320~325 (2009)
- Stein JP, "Long-term oncological outcomes in women undergoing radical cystectomy and orthotopic diversion for bladder cancer", J Urol, 181, pp.2052~2058 (2009)
- Large MC, "Orthotopic neobladder versus Indiana pouch in women : a comparison of health related quality of life outcomes", J Urol, 183, pp.201~206 (2010)
- Lee ES, "Awareness of Korean adults smokers about national smoking cessation program in Korea: findings from the 2016 International Tobacco Control Policy Evaluation Survey_Korea", J Korean Soc Res Nicotine Tob, 9(Suppl 1), pp.S22~S30 (2018)
- Kluth LA, "Gender-specific differences in clinicopathologic outcomes following radical cystectomy : an international multiinstitutional study of more than 8000 patients", Eur Urol, 66, pp.913~919 (2014)
- Brauers A, "Epidemiology and biology of human urinary bladder cancer", J Cancer Res Clin Oncol, 126, pp.575~583 (2000)
- Lee R, "The natural history of bladder cancer. Implications for therapy", Urol Clin North Am, 27, pp.1~13 (2000)
- Hollenbeck BK, "Delays in diagnosis and bladder cancer mortality", Cancer, 116, pp.5235~5242 (2010)
- Mommsen S, "Presenting symptoms, treatment delay and survival in bladder cancer", Scand J Urol Nephrol, 17, pp.163~167 (1983)
- Mansson A, "Time lag to diagnosis of bladder cancer : influence of psychosocial parameters and level of health-care provision", Scand J Urol Nephrol, 27, pp.363~369 (1993)
- Mungan NA, "Gender differences in stage distribution of bladder cancer", Urology, 55, pp.368~371 (2000)
- Saez S, "Evidence of estrogen receptors in the trigone area of human urinary bladder", J Steroid Biochem, 15, pp.317~320 (1981)
- Stein JP, "Indications for lower urinary tract reconstruction in women after cystectomy for bladder cancer : a pathological review of female cystectomy specimens", J Urol, 154, pp.1329~1333 (1995)