Frequency and determinants of reproductive organ involvement in female patients undergoing radical cystectomy for bladder cancer.

Abstract

699 Background: Traditionally, radical cystectomy (RC) in females includes removal of adjacent reproductive organs (RO) along with the bladder and regional lymph nodes. The growing adoption of reproductive organ-sparing RC underscores the need to better understand the frequency and preoperative predictors of reproductive organ involvement (ROI). Methods: We utilized our prospectively maintained, IRB-approved RC database to identify all female patients who underwent RC between 2003 and 2024. Patients with a history of prior surgery on ROs were excluded. Multivariate logistic regression model was applied to identify predictors of ROI. Results: A total of 324 female patients were included in the analysis, of whom 42 (13.0%) demonstrated ROI. Baseline characteristics are shown Table 1. The most involved RO was vagina (N=25, 7.7%), followed by the cervix (N=24, 7.4%), uterus (N=21, 6.5%), and fallopian tubes/ovaries (N=4, 1.2%). Among the 18 patients with involvement of a single RO, the vagina was the most frequently affected (N=10, 3.1%), followed by the uterus (N=5, 1.5%). The strongest correlations of ROI were observed between the cervix and uterus (r = 0.6) and between the vagina and cervix (r = 0.5; both p < .001). In multivariate analysis, extravesical disease (OR: 17.2, 95% CI: 6.8 – 43.1, p<.001) or lymph node positivity (OR: 17.5, 95% CI: 6.1 – 50.1, p=.001) in clinical staging, along with higher comorbidity burden (Charleson comorbidity index ≥ 2 vs. 0: OR: 3.7, 95% CI: 6.8 – 43.1, p= 0.020) were predictive of ROI. In patients with ROI, the median recurrence-free survival (RFS) and overall survival (OS) were 8.3 and 12.4 months, respectively. Predictably, log-rank analyses demonstrated significantly worse OS and RFS in patients with ROI compared to those without (both p<.001). Conclusions: ROI was identified in approximately 13% of female patients undergoing RC. Reproductive organ-sparing surgery should not be offered to patients presenting with extravesical or lymph node-positive disease, or those with a higher comorbidity burden. Demographics and perioperative characteristics stratified by reproductive organ involvement. Patient characteristics No ROI (N=282) ROI (N=42) P value Age (yrs.), mean ± SD 67.7 ± 11.0 67.9 ± 12.3 0.798 Charleson Comorbidity Index, n(%) 0.028  0 83 (29.4%) 5 (11.9%%)  1 84 (29.8%) 12 (28.6%)  >=2 115 (40.8%) 25 (59.5%) Clinical Staging, n(%) <0.001  Organ confined (≤ cT2N0) 218 (77.3%) 7 (16.7%)  Extravesical (> cT2N0) 39 (13.8%) 23 (54.8%)  Lymph node positive (cN+) 25 (8.9%) 12 (28.6%) Positive Bimanual Examination, n(%) 25 (8.9%) 11 (26.2%) <0.001 Neoadjuvant chemotherapy, n(%) 78 (27.7%) 16 (38.1%) 0.164