To develop and validate a nomogram assessing cancer and all-cause mortality following radical cystectomy. Given concerns regarding the morbidity associated with surgery, there is a need for incorporation of cancer-specific and competing risks into patient counseling and recommendations.
A total of 5,325 and 1,257 diagnosed with clinical stage T2-T4a muscle-invasive bladder cancer from January 1, 2006 to December 31, 2011 from Surveillance, Epidemiology, and End Results (SEER)-Medicare and Texas Cancer Registry (TCR)-Medicare linked-data, respectively. Cox proportional hazards models were used and a nomogram was developed to predict 3- and 5-year overall and cancer-specific survival with external validation.
Patients who underwent radical cystectomy were more likely to have been younger, male, married, non-Hispanic white and to have had fewer comorbidities than those who did not undergo radical cystectomy (p<0.001). Married patients, in comparison to their unmarried counterparts, had both improved overall (Hazard Ratio (HR) 0.76= 95% CI 0.70 to 0.83, p<0.001) and cancer-specific (HR 0.76= 95% CI 0.68 to 0.85, p<0.001) survival. A nomogram developed using SEER-Medicare data, predicted 3- and 5-year overall and cancer-specific survival rates with concordance indices of 0.65 and 0.66 in the validated TCR-Medicare cohort, respectively.
Older, unmarried patients with increased comorbidities are less likely to undergo radical cystectomy. We developed and validated a generalizable instrument which has been converted into an on-line tool (Radical Cystectomy Survival Calculator© (RCSC)), to provide a benefit-risk assessment for patients considering radical cystectomy.
Urology. 2017 Aug 25 [Epub ahead of print]
Stephen B Williams, Jinhai Huo, Yiyi Chu, Jacques G Baillargeon, Timothy Daskivich, Yong-Fang Kuo, Christopher D Kosarek, Simon P Kim, Eduardo Orihuela, Douglas S Tyler, Stephen J Freedland, Ashish M Kamat
Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX. Electronic address: ., Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX., Department of Medicine, Division of Epidemiology, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX., Department of Urology, Cedars Sinai Medical Center, Los Angeles, CA., Department of Medicine, Division of Biostatistics, Sealy Center on Aging, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX., Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX., Urology Institute, Center for Health Care Quality and Outcomes, University Hospitals Case Western Medical Center, Case Western Reserve University, Cleveland, OH; Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT., Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.