[Prognosis of local recurrence after radical cystectomy for bladder cancer]

The clinical outcome is poor for patients who have local recurrence after radical cystectomy for bladder cancer. We investigated clinical outcomes of patients with isolated local recurrence and with both local recurrence and distant metastasis. From 1990 to 2006, 299 patients who had bladder cancer without distant metastasis underwent radical cystectomy in our hospital. We included 200 patients who had a negative surgical margin at radical cystectomy and urothelial carcinoma, and who had not had upper urinary tract cancer or other active cancer. Fifteen (7.5%) had isolated local recurrence (isolated group) and 18 (9.0%) had local recurrence and distant metastasis simultaneously (simultaneous group). The median overall survival time and that for survival after recurrence were 24 and 13 months, respectively, in the isolated group, and 18 and 5 months, respectively, in the simultaneous group. Although we did not find a significant difference in overall survival (p = 0.314), there was one for survival after recurrence (p = 0.001) between the two groups. In the isolated group, 13 died of cancer, 1 of another cause and 1 was alive without cancer. All patients in the simultaneous group died of cancer. Three patients in the isolated group underwent surgery for residual tumors after systemic chemotherapy, and 2 of the 3 survived for more than 2 years after recurrence. Some patients with isolated local recurrence benefited from multimodal therapies. In these patients, surgery for the residual tumor after systemic chemotherapy was likely to be effective if a negative margin was achieved in surgical specimens.