Original research
Enumerating pelvic recurrence following radical cystectomy for
bladder cancer: A Canadian multi-institutional study
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Libni J. Eapen, MD; Edward Jones, MD; Wassim Kassouf, MD; Carole Lambert, MD;
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Scott C. Morgan, MD; Madeleine Moussa, MD; Robert Nam, MD; Matthew Parliament, MD;
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Laurie Russell, MD; Fred Saad, MD; D. Robert Siemens, MD; Luis Souhami, MD; Ewa Szumacher, MD;
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Scott Tyldesley, MD; Yan Xu, MD; Ingrid Zbieranowski, MD; Rodney H. Breau, MD; Eric Belanger, MD;
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Peter Black, MD; Eric Estey, MD; Julie Bowan, MD; Bishwajit Bora, MD; Michael Brundage, MD;
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Peter Chung, MD; Neil Fleshner, MD; Andrew Evans, MD; Glenn Bauman, MD; Jonathan Izawa, MD;
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Chris Davidson, MD; Fadi Brimo, MD
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The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada; BC Cancer Agency, BC, Canada; McGill University Health Centre, Montreal, QC, Canada; Notre-Dame Hospital, Montreal,
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QC, Canada; Queen’s University, Kinston, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; Université de
Montréal, Montreal, QC, Canada; Sudbury Cancer Centre, Sudbury, ON, Canada; Kingston Cancer Centre, Kingston, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; London Cancer
Centre, London, ON, Canada
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Cite as: Can Urol Assoc J 2016;10(3-4):90-4. http://dx.doi.org/10.5489/cuaj.3456
disease and the systemic micrometastatic tumour burden.
Unfortunately, cure rates have remained static for over two
decades, reflecting the lack of more effective systemic treat-
ment and a continuing problem with pelvic tumour eradica-
See related article on page 95.
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tion. We report the results of a Canadian academic centre
Abstract
survey designed to enumerate the proportion of patients
developing pelvic tumour recurrence following contempo-
rary cystectomy.
Introduction: We aimed to enumerate the rate of pelvic recurrence
following radical cystectomy at university-affiliated hospitals in
Canada.
Methods
Methods: Canadian, university-affiliated hospitals were invited to
participate. They were asked to identify the first 10 consecutive
patients undergoing radical cystectomy starting January 1, 2005,
who had urothelial carcinoma stages pT3/T4 N0-2 M0. The first 10
consecutive cases starting January 1, 2005 who met these criteria
were the patients submitted by that institution with information
regarding tumour stage, age, number of nodes removed, and last
known clinical status in regard to recurrence and patterns of failure.
Results: Of the 111 patients, 80% had pT3 and 20% pT4 disease,
with 62% being node-negative, 14% pN1, and 27% pN2; 57%
had 10 or more nodes removed. Cumulative incidence of pelvic
relapse was 40% among the entire group
In 2011, 17 university-affiliated cancer clinics across Canada
were invited to participate in this effort. Specifically, each
centre was asked to identify a trio of investigators comprised
of a pathologist, urologist, and radiation oncologist. Following
ethics approval, the pathologist generated a chronologically
accurate list of consecutive patients undergoing cystectomy
for bladder cancer starting January 1, 2005. To be eligible
for the study, the following criteria had to be met: 1) primary
urothelial carcinoma with or without any admixed other
histologies (no other primary histologies such as squamous,
adenocarcinoma, or small cell were included); 2) no known
hematogenous metastases or nodal involvement above the
iliac bifurcation; 3) surgery performed with curative intent
and no gross residual disease; 4) neoadjuvant or adjuvant
chemotherapy was permitted; 5) only pT3/T4 N0-2 stages.
The first 10 consecutive cases meeting these criteria, regard-
less of whether the subsequent clinical outcome was fully
known or not, constituted the required patient sample from
each institution. It was the expectation that this method
of case selection from each hospital’s surgical pathology
chronological record would minimize case selection bias.
Conclusions: This review demonstrates a high rate of pelvic tumour
recurrence following radical cystectomy for pT3/T4 urothelial cancer.
Introduction
The current gold standard management for locally advanced
urothelial bladder cancer consists of neoadjuvant chemo-
therapy, followed by radical cystectomy with pelvic node
dissection and neo-bladder reconstruction, as appropri-
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ate. This combination addresses the loco-regional pelvic
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CUAJ • March-April 2016 • Volume 10, Issues 3-4
2016 Canadian Urological Association
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