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Multicenter Study
. 2012 Nov 20;107(11):1826-32.
doi: 10.1038/bjc.2012.464.

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

E Xylinas  1 , E K Cha, M Sun, M Rink, Q-D Trinh, G Novara, D A Green, A Pycha, Y Fradet, S Daneshmand, R S Svatek, H-M Fritsche, W Kassouf, D S Scherr, T Faison, J J Crivelli, S T Tagawa, M Zerbib, P I Karakiewicz, S F Shariat
Affiliations
Multicenter Study

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

E Xylinas et al. Br J Cancer. .

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.

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Figures

Figure 1
Figure 1
Nomogram and conditional probability predictions of recurrence-free survival at 2, 5, and 7 years after radical cystectomy.
Figure 2
Figure 2
Nomogram and conditional probability predictions of cancer-specific survival at 2, 5, and 7 years after radical cystectomy.
Figure 3
Figure 3
External validation of the nomograms for predictions of recurrence-free survival (A) and cancer-specific survival (B) at 2, 5, and 7 years after radical cystectomy.
See this image and copyright information in PMC

References

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