Despite the favorable prognosis associated with pathologic T0 bladder cancer, relapse can occur, especially among patients with positive lymph nodes, investigators reported at the 22nd annual meeting of the Society of Urologic Oncology.

Using the International Robotic Cystectomy Consortium database, Ahmed Aly Hussein, MD, MS, and colleagues from Roswell Park Comprehensive Cancer Center in New York, New York, identified 471 patients with pT0 bladder cancer or absence of residual tumor at the time of robot-assisted radical cystectomy (RARC). Of the cohort, 37% had received neoadjuvant chemotherapy. Positive lymph nodes were found in 5%.

Bladder cancer relapsed in 7% of patients, including 3% with local and 5% with distal recurrence, Dr Hussein’s team reported. The most common sites of both local and distant recurrences were the pelvis (1%) and lungs (2%). No patient had peritoneal recurrence.

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At 5 years, recurrence-free, disease-free, and overall survival rates were 88%, 93% and 79%, respectively.

According to a multivariate model, positive lymph node status and reoperation within 30 days significantly increased the risk for recurrence by 10.2- and 7.1-fold, respectively, and all-cause mortality by 4.9- and 3.5-fold, respectively, Dr Hussein’s team reported. Chronic kidney disease was another risk factor for worse overall survival, and older age was another risk factor for recurrence. Predictors for disease-free survival could not be calculated due to the small number of patients.

In an interview, Dr Hussein stated that “pT0 at cystectomy has been considered a surrogate for complete response to neoadjuvant chemotherapy, and has been associated with improved survival. This has led some groups to recommend less stringent follow-up. However, our findings show 5% of patient had positive lymph nodes, and 7% experienced disease relapse, highlighting that close follow-up remains important even for those with pT0 status. Node status is the main predictor for recurrence in pT0.”


Elsayed AS, Iqbal U, Jing Z, et al. Relapses rates and patterns for pathological T0 after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Presented at the 22nd annual meeting of the Society of Urologic Oncology. December 1-3, 2021. Poster 6.

This article originally appeared on Renal and Urology News