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. 2015 Oct 29:5:246.
doi: 10.3389/fonc.2015.00246. eCollection 2015.

Disease-Free Survival at 2 and 3 Years is a Significant Early Surrogate Marker Predicting the 5-Year Overall Survival in Patients Treated with Radical Cystectomy for Urothelial Carcinoma of the Bladder: External Evaluation and Validation in a Cohort of Korean Patients

Hyung Suk Kim  1 , Chang Wook Jeong  1 , Cheol Kwak  1 , Hyeon Hoe Kim  1 , Ja Hyeon Ku  1
Affiliations

Disease-Free Survival at 2 and 3 Years is a Significant Early Surrogate Marker Predicting the 5-Year Overall Survival in Patients Treated with Radical Cystectomy for Urothelial Carcinoma of the Bladder: External Evaluation and Validation in a Cohort of Korean Patients

Hyung Suk Kim et al. Front Oncol. .

Abstract

Purpose: We aimed to externally validate the association of 2- and 3-year disease-free survival (DFS) with 5-year overall survival (OS) in patients treated with radical cystectomy (RC) for urothelial carcinoma (UC) of the bladder.

Materials and methods: We reviewed the clinical data of 422 patients who underwent RC for UC of the bladder in our institution between 1991 and 2012. Survival curves were plotted with the Kaplan-Meier method. The Kappa statistic and Kendall tau-b test were used to assess the agreements between 2- and 3-year DFS and 5-year OS.

Results: In the entire study population, 2- and 3-year DFS and 5-year OS rates were 76.4, 71.5, and 67.4%, respectively. All Kappa and Kendall's tau-b test values for agreements between 2- and 3-year DFS and 5-year OS were more than 0.40, indicating moderate agreement for all patients and in each patient subgroup selected according to specific variables (all p-values <0.05). Kaplan-Meier analysis for DFS and Cox-proportional hazard models for landmark analysis at each time point indicated that most recurrences occurred within 3 years after surgery. The 5-year OS rates of patients who were recurrence-free at each time point gradually increased to more than 95% in an extended recurrence-free interval of 12-36 months.

Conclusion: Our external validation results support the existing finding that 2- and 3-year DFS can be a valid early surrogate end point to predict 5-year OS after RC in patients with UC of the bladder.

Keywords: disease-specific survival; overall survival; radical cystectomy; surrogate; urothelial carcinoma.

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Figures

Figure 1
Figure 1
Overall survival and disease-free survival. (A) All patients. (B) Patients with pT2 or less disease. (C) Patients with pT3 or greater disease. Vertical bar represents 60 months.
Figure 2
Figure 2
Overall survival by disease status. (A) Overall survival of all patients by 2-year disease status. (B) Overall survival of patients with pT2 or less disease by 2-year disease status. (C) Overall survival of patients with pT3 or greater disease by 2-year disease status. (D) Overall survival of all patients by 3-year disease status. (E) Overall survival of patients with pT2 or less disease by 3-year disease status. (F) Overall survival of patients with pT3 or greater disease by 3-year disease status.
Figure 3
Figure 3
Hazard ratio of landmark analysis at each time point. (A) All patients. (B) Patients with pT2 or less disease. (C) Patients with pT3 or greater disease. Dashes indicate 95% confidence intervals.
Figure 4
Figure 4
Five-year survival rates of patients who achieved each outcome. (A) All patients. (B) Patients with pT2 or less disease. (C) Patients with pT3 or greater disease. The bars indicate 95% confidence interval.
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