Natural history of positive urinary cytology after radical cystectomy Journal Article


Authors: Raj, G. V.; Bochner, B. H.; Serio, A. M.; Vickers, A.; Donat, S. M.; Herr, H.; Lin, O.; Dalbagni, G.
Article Title: Natural history of positive urinary cytology after radical cystectomy
Abstract: Purpose: The natural history and risk of disease progression in patients with positive urine cytology after radical cystectomy for urothelial carcinoma has not been adequately elucidated. Materials and Methods: An institutional review board approved, retrospective review in patients undergoing radical cystectomy was performed to identify those with positive urinary cytology after radical cystectomy. Cox proportional hazards regression was used to determine factors associated with positive cytology after radical cystectomy and upper tract recurrence after positive cytology. Survival curves and probabilities were examined by Kaplan-Meier analysis. Results: A total of 101 patients with at least a single positive urinary cytology result after radical cystectomy were identified. Ureteral involvement in the radical cystectomy specimen was significantly associated with subsequent positive cytology. At the first positive urinary cytology only 9 of 101 patients (9%) had documented urothelial recurrence but eventually 57 of 101 had radiographic evidence of urothelial recurrence. Median freedom from radiological evidence of urothelial recurrence after positive cytology was 2.1 years and ureteral involvement was associated with a higher likelihood of urothelial recurrence. Despite surgical and chemotherapeutic interventions median survival after urothelial recurrence was 2.1 years. Conclusions: Urine cytology may have a valuable role for detecting upper tract recurrence after radical cystectomy. Most patients with positive cytology after radical cystectomy eventually have radiological evidence of urothelial recurrence. These data may help clarify natural history in patients with positive cytology after radical cystectomy. Additionally, these data indicate the need for diligent evaluation for recurrent disease and potentially the role of early adjuvant therapy in patients with positive cytology after radical cystectomy. © 2006 American Urological Association.
Keywords: adult; cancer chemotherapy; controlled study; aged; middle aged; cancer surgery; survival rate; retrospective studies; major clinical study; cancer recurrence; postoperative period; antineoplastic agent; cytology; neoplasm recurrence, local; retrospective study; bladder cancer; urinary bladder neoplasms; survival time; urothelium; proportional hazards model; cystectomy; surgical risk; carcinoma; urine; kaplan meier method; carcinoma, transitional cell; transitional cell; bladder; urine cytology
Journal Title: Journal of Urology
Volume: 176
Issue: 5
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2006-11-01
Start Page: 2000
End Page: 2005
Language: English
DOI: 10.1016/j.juro.2006.07.049
PUBMED: 17070236
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 4 June 2012" - "CODEN: JOURA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Ganesh Raj
    20 Raj
  2. Guido Dalbagni
    256 Dalbagni
  3. Sherri M Donat
    135 Donat
  4. Oscar Lin
    231 Lin
  5. Andrew J Vickers
    569 Vickers
  6. Angel M Cronin
    145 Cronin
  7. Bernard Bochner
    328 Bochner
  8. Harry W Herr
    410 Herr