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Vol. 45. Issue 6.
Pages 466-472 (July - August 2021)
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Vol. 45. Issue 6.
Pages 466-472 (July - August 2021)
Original article
Prognostic value of urinary cytology for detecting urothelial carcinoma recurrence after radical cystectomy
Valor pronóstico de la citología urinaria en la recidiva del carcinoma urotelial vesical tras la cistectomía radical
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A. Rodríguez-Serranoa,b,
Corresponding author
, D.M. Carrióna,b, J. Gómez Rivasa,b,c, M. Álvarez-Maestroa,b,c, S. Sánchezb,d, F. Rodríguez de Bethencourta,b,c, A. Aguilera Bazána,b,c, L. Martínez-Piñeiroa,b,c
a Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain
b Universidad Autónoma de Madrid, Madrid, Spain
c Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
d Servicio de Traumatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
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Tables (2)
Table 1. Perioperative and anatomopathologic characteristics and follow-up of 142 patients included in the study (2017 TNM classification, 8th edition and 1973 WHO classification system).
Table 2. Characteristics of the 9 patients who had recurrence in the remnant urothelium. Tumor staging: (2017 TNM classification system, 8th edition and 1973 WHO histological grade classification system).
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Abstract
Introduction

Urethral or upper urinary tract (UUT) recurrence of urothelial carcinoma (UC) after radical cystectomy (RC) are rare (4–6%), and their diagnosis usually occurs within the first two years. Although it is known that its early detection offers benefit in terms of survival, currently there are no clear recommendations for the detection of recurrence in the remnant urothelium (RU). Our aim is to determine the diagnostic value of urinary cytology for the detection of recurrences in the RU and to estimate its impact as an early diagnostic method on survival.

Material and methods

Retrospective review of patients who underwent RC for urothelial carcinoma between 2008–2016, with a follow-up of at least 24 months.

Results

The study included 142 patients. In a median follow-up of 68.5 months, nine patients (6.3%) presented recurrences in the RU (urethra: four, UUT: four, synchronous: one). The sensitivity and specificity of urinary cytology for the diagnosis of UUT recurrences were 20% and 96%, respectively. No significant differences were found between overall survival and cancer-specific survival among patients according to the urinary cytology results.

Conclusion

Recurrences in the RU after RC are infrequent; our study has shown that urinary cytology offers a low sensitivity for their diagnoses. For these reasons, we do not consider that urinary cytology provides useful information for surveillance of these patients.

Keywords:
Urinary cytology
Radical cystectomy
Remnant urothelium
Recurrence
Urothelial carcinoma
Resumen
Introducción

Las recidivas del carcinoma urotelial (CaU) en uretra o en el tracto urinario superior (TUS), tras una cistectomía radical (CR) son infrecuentes (4–6%), y su diagnóstico suele ocurrir en los 2 primeros años. Actualmente, no existen claras recomendaciones para la detección de recidivas en el urotelio remanente (UR), aunque se sabe que su detección precoz ofrece beneficios en la supervivencia. Nuestro objetivo es determinar el valor diagnóstico de la citología urinaria (CU) para la detección de recidivas en el UR y calcular su impacto como método de diagnóstico precoz en la supervivencia.

Material y métodos

Revisión retrospectiva de pacientes intervenidos de CR por CaU entre 2008–2016, con un seguimiento mayor de 24 meses.

Resultados

Se incluyeron 142 pacientes. En una mediana de seguimiento de 68,5 meses, 9 pacientes (6,3%) presentaron recidivas en el UR (uretra: 4, TUS: 4, sincrónica: uno). La sensibilidad de la CU para el diagnóstico de recidivas en el TUS fue del 20% y la especificidad del 96%. No se encontraron diferencias significativas entre la supervivencia global y la supervivencia cáncer específica entre pacientes según el resultado de la CU.

Conclusión

Las recidivas en el UR tras una CR son infrecuentes, y en nuestro estudio, hemos encontrado una baja sensibilidad para el diagnóstico de estas con CU. Por estas razones, no consideramos que la CU aporta información útil para el seguimiento de estos pacientes.

Palabras clave:
Citología urinaria
Cistectomía radical
Urotelio remanente
Recurrencia
Carcinoma urotelial

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