Cancer Res Treat.  2019 Jul;51(3):1064-1072. 10.4143/crt.2018.515.

Oncologic, Perioperative Outcomes of Female Radical Cystectomy: Results from a Multicenter Study in Korea

• Shim JS
• Seo HK
• Ku JH
• Jeong BC
• Hong B
• Kang SH
• UCART (Urothelial Cancer-Advanced Research and Treatment Group in Korea) Group

• KMID: 2454298
• DOI: http://doi.org/10.4143/crt.2018.515

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 periodwith 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.

Keyword

Cystectomy; Female; Urinary bladder neoplasms

MeSH Terms

Cohort Studies
Cystectomy*
Female*
Follow-Up Studies
Humans
Incidence
Korea*
Methods
Prognosis
Rage
Referral and Consultation
Retrospective Studies
Urinary Bladder Neoplasms
Urinary Diversion

Figure

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  Fig. 1. Descriptions of the initial symptoms.

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  Fig. 2. Differences in pathologic T category according to the period for the urologic referral from symptom onset (T2 category and over proportion is dramatically increased after 1 year as 88%).

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  Fig. 3. Changes in the rates of each surgical technique of female radical cystectomy during 10 years. (A) Open/laparoscopy/robotic. (B) Ileal conduit (IC)/orthotopic neobladder (ONB)/continent cutaneous urinary diversion (CCUD). (C) Anterior exenteration/organ sparing radical cystectomy (RC).

Reference

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