Title | Gynecologic Organ Involvement During Radical Cystectomy for Bladder Cancer: Is It Time to Routinely Spare the Ovaries? |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Taylor BL, Matrai CE, Smith AL, Ayangbesan A, Xia L, Golombos DM, Mosquera JMiguel, Nicolas J, Robinson BD, Scherr DS, Khani F |
Journal | Clin Genitourin Cancer |
Volume | 17 |
Issue | 1 |
Pagination | e209-e215 |
Date Published | 2019 Feb |
ISSN | 1938-0682 |
Keywords | Adenocarcinoma, Aged, Carcinoma, Small Cell, Carcinoma, Squamous Cell, Cystectomy, Female, Follow-Up Studies, Humans, Organ Sparing Treatments, Ovary, Prognosis, Retrospective Studies, Urinary Bladder Neoplasms |
Abstract | PURPOSE: To determine a subset of women who could undergo ovary-sparing radical cystectomy (OSRC) for bladder cancer without compromising oncologic safety. PATIENTS AND METHODS: A retrospective review was performed of 164 consecutive women who underwent cystectomy at a single tertiary-care center from 1997 to 2018. Clinicopathologic and preoperative radiographic data were reviewed. Univariable and multivariable logistic regression models adjusting for pathologic stage, lymphovascular invasion (LVI), and carcinomain-situ were performed to evaluate the risk of ovarian and reproductive organ (RO) involvement. RESULTS: A total of 123 women with a median age of 71 years underwent radical cystectomy (RC) with removal of ROs for primary bladder cancer. Nineteen women (15%) had RO involvement by bladder cancer, and 5 of them (4%) were specifically found to have ovarian involvement. Patients with ovarian involvement of bladder cancer had more locally advanced disease (P = .01), LVI (P = .003) and positive margins (P = .003). On multivariable logistic regression, ≥ pT3 (odds ratio = 10.2; 95% confidence interval, 2.0-51.6; P = .005) and LVI (odds ratio = 3.9; 95% confidence interval, 1.1-14.2; P = .037) were associated with increased risk of RO involvement. Among 15 patients excluded for having a nonbladder primary malignancy, a third had RO involvement, and 2 (13%) had ovarian metastases. No women in our cohort had a primary ovarian malignancy detected at the time of RC. CONCLUSION: Women with ovarian involvement by malignancy at the time of RC either had locally advanced disease with LVI or a non-bladder primary malignancy. The risk of incompletely resecting the primary malignancy would be rare if OSRC was performed on women with organ-confined (≤T2) urothelial carcinoma. |
DOI | 10.1016/j.clgc.2018.10.009 |
Alternate Journal | Clin Genitourin Cancer |
PubMed ID | 30470630 |
Related Faculty:
Brian Robinson, M.D. Francesca Khani, M.D. Juan Miguel Mosquera, M.D.