Role of routine computed tomography scan in the oncological follow up of patients treated by radical cystectomy for bladder cancer.

OBJECTIVES

To assess the impact of a prolonged follow-up schedule using computed tomography scan on oncological outcomes after radical cystectomy for bladder cancer.

METHODS

A single-center retrospective study was carried out. All patients who underwent a radical cystectomy for bladder cancer between 1992 and 2012 were included. The protocol for postoperative oncological follow up included a thoracoabdominal computed tomography scan twice per year for 2 years and then annually for life. The patients with tumor recurrence were divided into two groups: asymptomatic recurrences and recurrences diagnosed because of symptoms. Cancer-specific survivals were estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were used to determine the predictive factors of cancer-specific survival.

RESULTS

Overall, 331 patients were included in this analysis, and, of them, 48.5% had a cancer recurrence after a median follow up of 52.6 months. A total of 30 of these recurrences were diagnosed at routine follow up among asymptomatic patients (18.8%). A total of 50% of recurrences occurred during the first 6 months and 75% during the first year. Just 10 of the recurrences (6.3%) appeared more than 3 years after radical cystectomy. The 5-year cancer-specific survival was higher in patients with asymptomatic recurrences (15.7% vs 32.1%), but this difference was not statistically significant (P = 0.10). On multivariate analysis, detection of asymptomatic recurrence reached statistical significance (HR 0.55; P = 0.04).

CONCLUSION

Routine computed tomography scan surveillance after radical cystectomy for bladder cancer might provide a survival benefit. The risk of recurrence beyond 3 years seems to be low, and further studies are required to determine the role of routine computed tomography scan in the follow up beyond this timeframe.