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

Sunil H. Patel, Shirley Wang, Meredith R. Metcalf, Natasha Gupta, Andrew Gabrielson, Esther Lee, Mary Rostom, Phil Pierorazio, Armine Smith, Noah Hahn, Mark Schoenberg, Max Kates, Jean Hoffman-Censits, Trinity J. Bivalacqua

Research output: Contribution to journalArticlepeer-review

Abstract

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 not 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.

Original languageEnglish (US)
Pages (from-to)60-68
Number of pages9
JournalClinical Genitourinary Cancer
Volume20
Issue number1
DOIs
StatePublished - Feb 2022

Keywords

  • Bladder Cancer, Female cystectomy, Reproductive organ sparing, Variant Histology, advanced disease

ASJC Scopus subject areas

  • Oncology
  • Urology

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