Suzanne Stewart

PD31-01 SURVEILLANCE STRATEGIES IN BLADDER CANCER FOLLOWING RADICAL CYSTECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

INTRODUCTION AND OBJECTIVES: Thereisnoclearguidance on the surveillance of muscle invasive bladder cancer (MIBC) following radical cystectomy (RC) and the effect of surveillance onmortality is debatable. We conducted a systematic review to evaluate the characteristics of availablesurveillanceprotocolsanddeterminetheeffectonmortalitywith the detection of asymptomatic versus symptomatic recurrences. METHODS: An electronic search of PubMed, Medline, Embase and Cochrane Library databases was performed from 1970-2013. Three reviewers independently assessed the 1288 candidate studies for eligibility and abstracted data based on criteria priori established protocol. Outcomes were pooled using random effects meta-analysis. RESULTS: We included 7 retrospective studies with overall good quality. Four studies developed stage stratified surveillance protocols based on stage and recurrence location patterns. All protocols ended surveillance at 5 years and recommended imaging frequencies and techniques that only slightly differed. The detection of asymptomatic recurrences reduced mortality by 22% (RR 0.78, CI 0.58,1.04); this effect was statistically significant only when upper and lower urinary tract recurrences were included in analysis (Figure 1). CONCLUSIONS: Available surveillance protocols for MIBC following RC show several common components. There may be a reduction in mortality with asymptomatic detection that provides a rationale for surveillance.