Safety and Efficacy of Reproductive Organ-Sparing Radical Cystectomy in Women With Variant Histology and Advanced Stage

被引：13

作者：

Patel, Sunil H. ^{[1
]}

Wang, Shirley ^{[1
]}

Metcalf, Meredith R. ^{[2
]}

Gupta, Natasha ^{[1
]}

Gabrielson, Andrew ^{[1
]}

Lee, Esther ^{[1
]}

Rostom, Mary ^{[1
]}

Pierorazio, Phil ^{[4
]}

Smith, Armine ^{[1
]}

Hahn, Noah ^{[1
,2
]}

Schoenberg, Mark ^{[5
]}

Kates, Max ^{[1
]}

Hoffman-Censits, Jean ^{[1
,3
]}

Bivalacqua, Trinity J. ^{[4
]}

机构：

[1] Johns Hopkins Sch Med, Brady Urol Inst, 600 N Wolfe St,Pk 226, Baltimore, MD 21287 USA

[2] NYU, Dept Urol, New York, NY USA

[3] Johns Hopkins Sch Med, Dept Oncol, Baltimore, MD USA

[4] Univ Penn, Div Urol, Philadelphia, PA 19104 USA

[5] Einstein Sch Med, Montefiore Med Ctr, Dept Urol, Bronx, NY USA

来源：

CLINICAL GENITOURINARY CANCER | 2022年 / 20卷 / 01期

基金：

美国医疗保健研究与质量局;

关键词：

Bladder Cancer; Female cystectomy; Reproductive organ sparing; Variant Histology; advanced disease; INVASIVE BLADDER-CANCER; ANTERIOR EXENTERATION; OVARIAN CONSERVATION; GYNECOLOGIC ORGANS; FEMALE-PATIENTS; NEOBLADDER; INVOLVEMENT; PRESERVATION; REPLACEMENT; OUTCOMES;

D O I：

10.1016/j.clgc.2021.11.005

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Muscle invasive bladder cancer surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females, however role of removal of sexual organs is unknow. A retrospective single institutional analysis was performed to identify risk of reproductive involvement. Reproductive sparing surgery, even in variant histology or advance disease, did not compromise oncological outcomes in this cohort. Purpose: Muscle invasive bladder cancer surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine, ovarian, and vaginal preservation are utilized, but raise concerns regarding risk to oncologic control, especially in variant histopathology or advanced stage. Materials and Methods: A retrospective single institutional analysis identified radical cystectomies performed in women, including those with variant histology, which were defined as reproductive organ sparing (uterine, vaginal, and ovary sparing) or nonorgan sparing. The Kaplan-Meier method was used for recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in patients with advanced disease. Results: From 2000 to 2020, 289 women were identified, 188 underwent reproductive organ-sparing cystectomy. No statistical differences were noted for clinical parameters or presence of variant histology for organ-sparing (ROS) and nonorgan-sparing (non-ROS). Positive margin rates did no differ for ROS and non-ROS; 4.3% vs. 7.9%, P = .19, respectively. Median RFS was not statistically significantly different for ROS vs. non-ROS (26.1 vs. 15.3 months) P = .937 hazard ratio (HR) 1.024. CSS was not statistically different for ROS vs. non-ROS (36.3 vs. 28.6 months), P = .755 HR 0.9. OS was not statistically different for ROS vs. non-ROS (25.8 vs. 23.8 months), P = .5 HR = 1.178. Variant histology did not change survival (HR 1.1, P = .643). Conclusion: In this analysis, ROS in women with advanced disease did not increase positive margin rates or decrease RFS, CSS, or OS compared to non-ROS. Variant histology did not decrease survival odds. Based on preoperative assessment and intraoperative findings, ROS in patients with variant histology and advanced disease should be considered. (C) 2021 Elsevier Inc. All rights reserved.

引用

页码：60 / 68

页数：9