Local recurrence after radical cystectomy for invasive bladder cancer: an analysis of predictive factors.

OBJECTIVES: To examine which clinicopathologic parameters predict clinically detectable local recurrence after radical cystectomy. Local recurrence after radical cystectomy for invasive bladder cancer was infrequently observed until 20 years ago because of the lack of adequate diagnostic tools. The recent development and use of pelvic computed tomography has allowed us to detect local recurrence more precisely. However, only a few studies have investigated the rate and pattern of local recurrence in the computed tomography era.
METHODS: This retrospective review included 145 patients with muscle-invasive bladder cancer treated with radical cystectomy, regional pelvic lymph node dissection, and urinary diversion between January 1990 and December 2001. The development of local recurrence and/or distant metastasis was analyzed as the endpoint using univariate and multivariate analyses.
RESULTS: Local recurrence developed in 27 (18.6%) of the 145 patients at a median of 8 months after cystectomy. Of the 27 patients, 8 had local recurrence alone and 19 had concurrent distant metastasis. Distant metastasis without local recurrence developed in 34 patients (23.4%). Univariate and multivariate analyses revealed that Stage pT3-T4 and pathologic pelvic lymph node involvement were statistically significant factors predicting clinical failure, local recurrence, and/or distant metastasis. However, a concomitant squamous cell carcinoma component in the specimen was the only independent predictor of local recurrence alone in both univariate and multivariate analyses.
CONCLUSIONS: Only the finding of a concomitant squamous cell carcinoma component in the specimen was an independent predictor of local recurrence in patients treated with radical cystectomy.