Risk stratification of pT1-3N0 patients after radical cystectomy for adjuvant chemotherapy counselling - Abstract

Background: In pT1-T3N0 urothelial carcinoma of the bladder (UCB) patients, multi-modal therapy is inconsistently recommended.

The aim of the study was to develop a prognostic tool to help decision-making regarding adjuvant therapy.

Methods: We included 2145 patients with pT1-3N0 UCB after radical cystectomy (RC), naive of neoadjuvant or adjuvant therapy. The cohort was randomly split into development cohort based on the US patients (n=1067) and validation cohort based on the Europe patients (n=1078). Predictive accuracy was quantified using the concordance index.

Results: With a median follow-up of 45 months, 5-year recurrence-free and cancer-specific survival estimates were 68% and 73%, respectively. pT-stage, ge, lymphovascular invasion, and positive margin were significantly associated with both disease recurrence and cancer-specific mortality (P-values ≤ 0.005). The accuracies of the multivariable models at 2, 5, and 7 years for predicting disease recurrence were 67.4%, 65%, and 64.4%, respectively. Accuracies at 2, 5, and 7 years for predicting cancer-specific mortality were 69.3%, 66.4%, and 65.5%, respectively. We developed competing-risk, conditional probability nomograms. External validation revealed minor overestimation.

Conclusion: Despite RC, a significant number of patients with pT1-3N0 UCB experience disease recurrence and ultimately die of UCB. We developed and externally validated competing-risk, conditional probability post-RC nomograms for prediction of disease recurrence and cancer-specific mortality.

Written by:
Xylinas E, Cha EK, Sun M, Rink M, Trinh QD, Novara G, Green DA, Pycha A, Fradet Y, Daneshmand S, Svatek RS, Fritsche HM, Kassouf W, Scherr DS, Faison T, Crivelli JJ, Tagawa ST, Zerbib M, Karakiewicz PI, Shariat SF.   Are you the author?
Department of Urology, Weill Cornell Medical College, Starr 900, 525 East 68th Street, Box 94, New York, NY 10065, USA; Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France.

Reference: Br J Cancer. 2012 Nov 20;107(11):1826-32.
doi: 10.1038/bjc.2012.464


PubMed Abstract
PMID: 23169335

UroToday.com Bladder Cancer Section