Alberto Martini, Luca Afferi, Stefania Zamboni, Julianne G Schultz, Chiara Lonati, Agostino Mattei, R Jeffrey Karnes, Matteo Soligo, Armando Stabile, Ettore Di Trapani, Ottavio De Cobelli, Giuseppe Simone, Claudio Simeone, Mario Alvarez-Maestro, Giorgio Gandaglia, Andrea Gallina, Renzo Colombo, Alberto Briganti, Francesco Montorsi, Evanguelos Xylinas, Shahrokh F Shariat, Marco Moschini,
<h4>Purpose</h4>Presently, major guidelines do not provide specific recommendations on oncologic surveillance for patients who harbor VH BCa at radical cystectomy. We aimed to create a personalized follow-up scheme that dynamically weighs OCM versus the risk of recurrence for VH BCa, and to compare it with a similar one for pUC.<h4>Methods</h4>Within a multi-institutional registry, 528 and 1,894 patients with VH BCa and pUC, were identified. The Weibull regression was used to detect the time points after which the risk of OCM exceeded the one of recurrence during follow-up. The risk of OCM over time was stratified based on age and comorbidities, whereas the risk of recurrence on pathologic stage and recurrence site.<h4>Results</h4>Individuals with VH had a higher risk of recurrence (recurrence-free survival: 30% vs 51% at 10-year, p <0.001) and shorter median time to recurrence (88 vs 123 months, p <0.01) relative to pUC. Among VH, micropapillary variant conferred the greatest risk of recurrence on the abdomen and lungs, mixed variants carried the greatest risk of metastasizing to bones and other sites compared to pUC. Overall, surveillance should be continued for a longer time for individuals with VH BCa. Notably, patients younger than 60 years with VH and pT0/Ta/T1/N0 at RC should continue oncologic surveillance after 10 years versus 6.5 years of pUC individuals.<h4>Conclusions</h4>VH BCa is associated with greater recurrence risk than pUC. A follow-up scheme ie, valid for pUC should not be applied to individuals with VH. Herein, we present a personalized approach for surveillance that may allow an improved shared-decision.
J Urol (The Journal of urology)
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