gms | German Medical Science

Background: To investigate whether a previous history of malignancy is of prognostic value in women with bladder cancer (BC) undergoing radical cystectomy (RC).

Methods: We conducted an analysis of 83 women who were treated with RC for BC between 2002 and 2013. All women were staged cM0 at RC and were considered free of disease from previous malignancies. Descriptive statistics were used for correlation with clinicopathological parameters and uni- and multivariable analysis for risk factors of cancer-specific (CSS) and overall survival (OS). The median follow-up was 35 months (IQR: 8-55).

Results: Of the 83 women, 17 (20.5%) had a history of malignancy prior to diagnosis of BC. In these 17 women, a total of 20 malignancies were diagnosed and treated prior to RC. Nine women had previous gynecological cancer (3 women with uterus, 3 with ovarian, 2 with breast and 1 with cervix cancer) and six women a history of non-gynecological malignancies (2 with renal cancer, 2 with bronchial and two with suprarenal and skin cancer or thyroid cancer). Two women had a history of both gynecological and non-gynecological cancer (breast plus colorectal and cervical plus colorectal cancer). A history of prior gynecological malignancy was associated with a previous history of colorectal cancer (p=0.016), tumor size (continuously coded; p=0.001), elevated platelet count (p<0.001) and elevated serum C-reactive protein (p=0.039) and decreased hemoglobin levels (p=0.020). In the total cohort, women with previous gynecological malignancies exhibited inferior cancer-specific (55.6% vs. 78.2%; p=0.08) and overall survival rates (23.6% vs. 66.6%; p=0.002) compared to women without whereas a previous non-gynecological malignancy did not exhibit a significant impact on CSS (p=0.52) and OS (p=0.17). In multivariable analysis, adjusted for standard histopathological risk factors, a positive soft-tissue surgical margin status and a history of previous gynecological malignancy were the only independent predictors of lower CSS (p<0.001/p=0.002) and OS (both p<0.001).

Conclusions: Despite being free from gynecological tumor disease, women with a history of gynecological malignancy exhibit adverse clinicopathological risk factors and lower survival rates after RC for BC.