Can we challenge the norm of routine post-cystectomy surveillance with imaging?
Author(s):
Mr Kawa Omar
,
Mr Kawa Omar
Affiliations:
Dr Martina Smekal
,
Dr Martina Smekal
Affiliations:
Mr Brian Parsons
,
Mr Brian Parsons
Affiliations:
Mr Raj Nair
,
Mr Raj Nair
Affiliations:
Mr Ramesh Thurairaja
,
Mr Ramesh Thurairaja
Affiliations:
Professor Shamim Khan
Professor Shamim Khan
Affiliations:
BAUS ePoster online library. Omar K. 06/26/17; 177344; P1-17 Disclosure(s): I have nothing to declare
Mr. Kawa Omar
Mr. Kawa Omar
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Abstract
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Introduction
The current guidelines for surveillance of bladder cancer after cystectomy are based on data in era where cross-sectional imaging was not in routine use. The aim of this study is to demonstrate whether the follow-up schedules with cross-sectional imaging provides survival benefit.
Materials and Methods:
A retrospective analysis of data between 2003-2016 was conducted. Only patients who underwent radical cystectomy with curative intent were included. The patients had follow-up CT scans of chest and CT-urograms tailored to the final TNM staging.
Results:
In total 404 patients (male 310, female 94) with a median age of 68 years (range35-83) were followed up for a median of 28.5months (range1-154). A total of 120 (29.6%) developed recurrence. 61 were detected on surveillance CT and 59 on CT scans guided by symptoms. Median time to recurrence in the surveillance group was 11 months (range3-42) compared to 14 months (range1-88) for symptomatic recurrences. The post-operative histology and histology of recurrences are demonstrated in table (1).
49/61 patients with recurrence detected on surveillance CT died from disease progression with 13 months’ median survival. In the symptomatic group 52/59 patients died from disease progression with a median survival of 4 months. The difference between the survival curves of the two groups was statistically significant (Pvalue 0.0005 on log-rank test) in favour of the recurrences detected on CT surveillance.
Conclusion:
CSS is longer in patients with recurrent disease detected on surveillance CT scans compared to recurrences detected on symptom-guided imaging. This justifies the use of CT surveillance protocols following radical cystectomy.
Introduction
The current guidelines for surveillance of bladder cancer after cystectomy are based on data in era where cross-sectional imaging was not in routine use. The aim of this study is to demonstrate whether the follow-up schedules with cross-sectional imaging provides survival benefit.
Materials and Methods:
A retrospective analysis of data between 2003-2016 was conducted. Only patients who underwent radical cystectomy with curative intent were included. The patients had follow-up CT scans of chest and CT-urograms tailored to the final TNM staging.
Results:
In total 404 patients (male 310, female 94) with a median age of 68 years (range35-83) were followed up for a median of 28.5months (range1-154). A total of 120 (29.6%) developed recurrence. 61 were detected on surveillance CT and 59 on CT scans guided by symptoms. Median time to recurrence in the surveillance group was 11 months (range3-42) compared to 14 months (range1-88) for symptomatic recurrences. The post-operative histology and histology of recurrences are demonstrated in table (1).
49/61 patients with recurrence detected on surveillance CT died from disease progression with 13 months’ median survival. In the symptomatic group 52/59 patients died from disease progression with a median survival of 4 months. The difference between the survival curves of the two groups was statistically significant (Pvalue 0.0005 on log-rank test) in favour of the recurrences detected on CT surveillance.
Conclusion:
CSS is longer in patients with recurrent disease detected on surveillance CT scans compared to recurrences detected on symptom-guided imaging. This justifies the use of CT surveillance protocols following radical cystectomy.
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