PD42-03: Oncologic surveillance intensity for variant histology versus pure urothelial carcinoma of the bladder after radical cystectomy

Alberto Martini, Riccardo Leni, Giuseppe Basile*, Simone Scuderi, Mario De Angelis, Luigi Nocera, Giuseppe Rosiello, Giorgio Gandaglia, Milan, Italy, Chiara Lonati, Luca Afferi, Lucerne, Switzerland, Vincenzo Mirone, Naples, Italy, Andrea Gallina, Lugano, Switzerland, Francesco Montorsi, Alberto Briganti, Marco Moschini, Milan, Italy

Introduction: There is paucity of data to justify the current follow-up schemes after radical cystectomy (RC) suggested from present guidelines and presently, major guidelines do not provide specific recommendations on oncologic surveillance for patients who harbor variant histology bladder cancer (VH BCa) at radical cystectomy, which is known to be associated with higher recurrence risk after radical treatment compared to pure urothelial carcinoma (pUC). On these premises to evaluate whether the EAU surveillance scheme after radical cystectomy is applicable to patients who harbor VH BCa

Methods: Within a multi-institutional registry, 528 and 1,894 patients with VH BCa and pUC, were identified form a multi-institutional database. Patients were followed up in compliance with the EAU guidelines which entail cross-sectional imaging biannually till the 3rd year and annually thereafter. The non-cumulative incidence of recurrence over time was evaluated through the LOWESS method

Results: Median follow-up of 6.5 years. Among patients with pUC, 628 patients experienced a BCa-related recurrence, among individuals with VH BCa, 207 patients experienced a BCa-related recurrence. The VH cancers were as follows: 48 (9%) non-urothelial variants, 52 (10%) mixed variants, 155 (29%) squamous variant, 74 (14%) micropapillary variant, 152 (29%) had other urothelial variants, and 47 (9%) no residual disease on final pathology Overall, individuals with VH had a higher risk of recurrence (recurrence-free survival: 30% vs 51% at 10-year, p<0.001) and shorter median time to recurrence (88 vs 123 months, p<0.01) relative to pUC. Figure 1 displays the non-cumulative incidence of recurrence after RC. Vertical lines correspond to the time points where imaging should be obtained. Overall, the non-cumulative risk of recurrence was always higher for VH BCa

Conclusions: Our study confirms that VH BCa is associated with greater recurrence risk than pUC. A follow-up scheme that is valid for pUC should not be applied to individuals with VH. Patients should be counseled for a more intense surveillance scheme if they are found to harbor VH BCa relatively to individuals with pUC

Source of Funding: no