Vaginal cuff recurrence after radical cystectomy: an under - studied site of bladder cancer relapse

Vaginal cuff recurrence after radical cystectomy: an under - studied site of bladder cancer relapse

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ABSTRACT Introduction: Vaginal cuff recurrence of tumor following radical cystectomy is a rare site of disease recurrence, however it has never been specifically studied.The aim of the study is to evaluate incidence, risk factors, and long-term oncologic outcomes of vaginal cuff recur- rence in a cohort of female patients treated with radical cystectomy for invasive urothelial carcinoma of the bladder.Materials and Methods: From 1985 to 2012, a prospectively maintained institutional blad- der cancer registry was queried for vaginal cuff recurrence post radical cystectomy.Over- all mortality and cancer-specific mortality were reported using the Kaplan-Meier method for patients with vaginal cuff recurrence, recurrence at another local or distant site, and those without evidence of here recurrence.Comparisons were performed using the log-rank test.

Cox proportional hazards regression model was performed to assess predictors of vaginal cuff recurrence.Results: From 469 women treated with radical cystectomy for bladder cancer, 34 patients (7.3%) developed vaginal cuff recurrence, 130 patients (27.7%) had recurrence involving ei- ther a local or distant site, and 305 patients (65%) had no evidence of recurrence.The 5-year overall mortality-free survival rate was 32.

4% for vaginal cuff recurrence, but 25.0% for other sites of recurrence.Cancer-specific mortality-free survival rate My Mom Dad Is Well Trained Funny Cartoon Dog Gift For Dog Lover Personalized Shirt was 32.4% for vaginal cuff recurrence, and 30.3% for the other sites of recurrence.

Multivariate Cox proportional hazards regression analysis demonstrated that the presence of tumor in posterior location at radical cystectomy (Hazard Ratio [HR], 0.353 [95% CI, 0.159-0.783]) and anterior vaginec- tomy, compared to no vaginectomy (HR, 2.595 [95% CI, 1.

077-6.249]) were independently associated with vaginal cuff recurrence.Conclusion: Anterior vaginectomy, despite our best attempts, is perhaps not sufficient to prevent vaginal cuff recurrence.Therefore, follow-up evaluation is essential, and further studies are necessary to address the optimal approach for initial management.Patient Summary: Although vaginal cuff recurrence is an unusual site of recurrence, careful evaluation is needed before cystectomy and during follow-up to identify patients at risk.