Presented by Pranjal Agrawal, Medical Student

 

Rates of Ovarian Cancer after Radical Cystectomy for Bladder Cancer

P. Agrawal¹, D. Subramaniam², R. Stone¹, S. Patel¹, A. Smith¹, M. Kates¹

¹Johns Hopkins University School of Medicine, Baltimore, MD, USA; ²Southern Illinois University of Edwardsville, Edwardsville, IL, USA

Introduction and Objective: AUA guidelines for radical cystectomy (RC) in women recommend removing adjacent reproductive organs including ovaries to reduce subsequent ovarian cancer (OC) risk.  However, the most common histologic type of OC is now thought to originate from the fallopian tubes and many organizations now recommend bilateral salpingectomy (BS) for OC risk reduction at the time of abdominal surgery. In the setting of ongoing debate regarding oophorectomy with RC, rates of OC in a female population undergoing RC for bladder cancer need to be defined. 

Methods: A retrospective cohort study was conducted via TriNetX after IRB approval. Baseline demographic and clinical data were compared among patients undergoing RC and RC with concurrent bilateral salpingo-oophorectomy (BSO).  Logistic regression analysis was used to establish associations between surgery performed and downstream comorbid diseases. 

Results: 1,133 patients underwent RC; 3 RC+BS, and 150  RC+BSO. At baseline, groups did not differ in age, race, ethnicity, or oncologic family or personal history; significant differences were noted in BMI, HTN, HLD, and overweight/obesity. Among those with RC, 1.8% developed ovarian/peritoneal cancer. No significant differences were noted in development of adverse effects between RC and RC+BSO groups (Table 1). No significant difference in all-cause mortality observed between RC and RC+BSO groups (HR = 0.997 [0.827 – 1.203], log-rank p=0.979).

Conclusions: Our study shows 1.8% of females undergoing RC for bladder cancer develop OC. This is consistent with lifetime OC risk in general population. Current performance of BS in lieu of BSO at RC is less than 1[RS1] [PA2] %. Whether BS can replace BSO for ovarian cancer risk reduction at the time of RC in patients with no known or suspected genetic risk for OC warrants further study.