STOCKHOLM, SWEDEN (UroToday.com) - The aim of this multi-center study was to identify prognosticators of disease recurrence (RC), other than Karnofsky performance status (KPS) and presence of visceral metastases (Bajorin criteria), after radical cystectomy (RC) for patients with urothelial carcinoma of the bladder (UCB).
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They identified 967 patients who underwent RC at 17 centers who experienced disease recurrence (DR) during the course of follow-up. Total of 372 patients with complete charts and follow-up were included in the final analysis. They used a forward step-wise selection process for final multivariable analysis (MVA). During a course of follow-up (18 months), 266 patients died of disease, with first year cancer-specific survival rate of 9%, 76%, and 47% for patients with no (n=105), one (n=180), and two (n=87) risk factors (p < 0.001).
They reported, on MVA, higher ASA score, anemia, leukocytosis, poor Karnofsky performance status (KPS<80%), and shorter time to DR were all independently associated with increased CSM, (p-value < 0.034). In addition, the combination of time to DR and KPS resulted in an improved discrimination. To date, among patients with metastatic urothelial carcinoma, a poor KPS and the presence of visceral metastases (i.e., Bajorin criteria) are known poor prognosticators of CSM. Results from this multi-institutional study show the significance of prognostic value of these two, and some additional reported variables in this study are associated with CSM in patients with UCB.
Based on these variables, the authors constructed a nomogram which allows clinicians to better predict survival and CSM after DR. Before wide acceptance or utilization of this nomogram for patient counseling, these findings should be externally validated.
Presented by Kluth, L.A.,1 Xylinas, E.,1 Rieken, M.,1 Kent, M.,2 Ikeda, M.,3 Matsumoto, K.,3 Hagiwara, M.,4 Kikuch, E.,4 Bing, M.T.,5 Gupta, A.,5 Sewell, J.M.,6 Konety, B.R.,6 Todenhöfer, T.,7 Schwentner, C.,7 Masson-Lecomte, A.,8 Vordos, D.,8 Roghmann, F.,9 Noldus, J.,9 Razmaria, A.A.,10 Smith, N.D.,10 Comploj, E.,11 Pycha, A.,11 Baniel, J.,12 Mano, R.,12 Novara, G.,13 Aziz, A.,14 Fritsche, H-M.,14 Brisuda, A.,15 Bivalacqua, T.,16 Gontero, P.,17 Boorjian, S.A.,18 Vickers, A.,2 and Shariat, S.F.19 at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden
1Weill Medical College of Cornell University, Dept. of Urology, Brady Urologic Health Center, New York, United States of America, 2Memorial Sloan-Kettering Cancer Center, Dept. of Epidemiology and Biostatistics, New York, United States of America, 3Kitasato University School of Medicine, Dept. of Urology, Minami-Ku, Sagamihara, Kanagawa, Japan, 4Keio University School of Medicine, Dept. of Urology, Tokyo, Japan, 5University of Iowa Hospitals and Clinics, Dept. of Urology, Iowa City, United States of America, 6University of Minnesota School of Medicine, Dept. of Urology, Minnesota, United States of America, 7University Medical Hospital of Tübingen, Dept. of Urology, Tübingen, Germany, 8Hôpital Henri Mondor Créteil, Dept. of Urology, Creteil, France, 9Ruhr University Bochum, Marienhospital, Dept. of Urology, Herne, Germany, 10University of Chicago Medicine and Biological Sciences Division, Dept. of Surgery, Section of Urology, Chicago, United States of America, 11General Hospital of Bolzano, Dept. of Urology, Bolzano, Italy, 12Rabin Medical Center, Dept. of Urology, Petah-Tikva, Israel,13University of Padua, Dept. of Surgical, Oncological and Gastroenterologic Sciences, Urology Clinic, Padua, Italy, 14Caritas St. Josef Medical Centre, Dept. of Urology, Regensburg, Germany, 15Hospital Motol, Charles University, Dept. of Urology, 2nd Faculty of Medicine, Prague, Czech Republic, 16Johns Hopkins Medical Institutions, The James Buchanan Brady Urological Institute, Baltimore, United States of America, 17Molinette University Hospital, Dept. of Urology, Turin, Italy, 18Mayo Medical School and Mayo Clinic, Dept. of Urology, Rochester, United States of America, 19Medical University of Vienna, Dept. of Urology, Vienna, Austria
Written by Reza Mehrazin, MD, medical writer for UroToday.com