Nomogram Predicting Bladder Cancer-specific Mortality After Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle-invasive Bladder Cancer: Results of an International Consortium.

Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) is associated with improved overall and cancer-specific survival. The post-NAC pathological stage has previously been reported to be a major determinant of outcome.

To develop a postoperative nomogram for survival based on pathological and clinical parameters from an international consortium.

Between 2000 and 2015, 1866 patients with MIBC were treated at 19 institutions in the USA, Canada, and Europe. Analysis was limited to 640 patients with adequate follow-up who had received three or more cycles of NAC.

A nomogram for bladder cancer-specific mortality (BCSM) was developed by multivariable Cox regression analysis. Decision curve analysis was used to assess the model's clinical utility.

A total of 640 patients were identified. Downstaging to non-MIBC (ypT1, ypTa, and ypTis) occurred in 271 patients (42 %), and 113 (17 %) achieved a complete response (ypT0N0). The 5-yr BCSM was 47.2 % (95 % confidence interval [CI]: 41.2-52.6 %). On multivariable analysis, covariates with a statistically significant association with BCSM were lymph node metastasis (hazard ratio [HR] 1.90 [95% CI: 1.4-2.6]; p < 0.001), positive surgical margins (HR 2.01 [95 % CI: 1.3-2.9]; p < 0.001), and pathological stage (with ypT0/Tis/Ta/T1 as reference: ypT2 [HR 2.77 {95 % CI: 1.7-4.6}; p < 0.001] and ypT3-4 [HR 5.9 {95 % CI: 3.8-9.3}; p < 0.001]). The area under the curve of the model predicting 5-yr BCSM after cross validation with 300 bootstraps was 75.4 % (95 % CI: 68.1-82.6 %). Decision curve analyses showed a modest net benefit for the use of the BCSM nomogram in the current cohort compared with the use of American Joint Committee on Cancer staging alone. Limitations include the retrospective study design and the lack of central pathology.

We have developed and internally validated a nomogram predicting BCSM after NAC and radical cystectomy for MIBC. The nomogram will be useful for patient counseling and in the identification of patients at high risk for BCSM suitable for enrollment in clinical trials of adjuvant therapy.

In this report, we looked at the outcomes of patients with muscle-invasive bladder cancer in a large multi-institutional population. We found that we can accurately predict death after radical surgical treatment in patients treated with chemotherapy before surgery. We conclude that the pathological report provides key factors for determining survival probability.

European urology focus. 2020 Aug 05 [Epub ahead of print]

Maria Carmen Mir, Michele Marchioni, Homi Zargar, K Zargar-Shoshtari, A S Fairey, Laura S Mertens, C P Dinney, L M Krabbe, M S Cookson, N E Jacobsen, J Griffin, J S Montgomery, N Vasdev, E Y Yu, E Xylinas, J S McGrath, W Kassouf, M A Dall'Era, S S Sridhar, J Aning, S F Shariat, J L Wright, A C Thorpe, T M Morgan, J M Holzbeierlein, T J Bivalacqua, S North, D A Barocas, Y Lotan, P Grivas, A J Stephenson, J B Shah, B W van Rhijn, P E Spiess, D Daneshmand, P C Black

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Fundacion Instituto Valenciano Oncologia, Valencia, Spain. Electronic address: ., Department of Medical, Oral and Biotechnological Sciences, Urology Unit, University "G. d'Annunzio", Chieti-Pescara, Italy., Department of Urologic Sciences, University of British Columbia, Vancouver, Canada., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., University of Alberta, Edmonton, Alberta, Canada., Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Münster, Münster, Germany., Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA., Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA., Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA., Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK., Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France., Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK., Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada., Department of Urology, University of California at Davis, Davis Medical Center, Sacramento, CA, USA., Princess Margaret Hospital, Toronto, Ontario, Canada., Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK; Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK., Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; UT Southwestern, Dallas, TX, USA; Charles University, Prag, Czech Republic; University of Jordan, Amman, Jordan., Department of Urology, University of Washington, Seattle, WA, USA., Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA., Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, RUSH University, Chicago, IL, USA., Department of Urology, MD Anderson Cancer Center, Houston, TX, USA; Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA.

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