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| European urology focus. 2015 May 28. pii: S2405-4569(15)00004-8. doi: 10.1016/j.euf.2014.10.003 |
| Prognostic Model for Predicting Survival in Patients with Disease Recurrence Following Radical Cystectomy. |
| Kluth LA1, Xylinas E2, Rieken M3, Kent M4, Ikeda M5, Matsumoto K6, Hagiwara M7, Kikuchi E8, Bing MT9, Gupta A10, Sewell JM11, Konety BR12, Todenhöfer T13, Schwentner C14, Masson-Lecomte A15, Vordos D16, Roghmann F17, Noldus J18, Razmaria AA19, Smith ND20, Comploj E21, Pycha A22, Rink M23, Baniel J24, Mano R25, Novara G26, Aziz A27, Fritsche HM28, Brisuda A29, Bivalacqua T30, Gontero P31, Boorjian SA32, Vickers AJ33, Shariat SF34 |
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Abstract BACKGROUND: Although the natural history of urothelial carcinoma of the bladder (UCB) from radical cystectomy (RC) to disease recurrence (DR) has been investigated intensively, the course of patients who have experienced DR after RC for UCB remains poorly understood. OBJECTIVE: To evaluate the prognostic value of the Bajorin criteria that consists of two risk factors: Karnofsky performance status (KPS) and the presence of visceral metastases (VMs) in patients with DR after RC for UCB. Furthermore, to identify additional factors associated with cancer-specific mortality (CSM) and thus build a multivariable model to predict survival after DR. DESIGN, SETTING, AND PARTICIPANTS: We identified 967 patients with UCB who underwent RC at 17 centers between 1979 and 2012 and experienced DR. Of these, 372 patients had complete data we used for analysis. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Univariable Cox regressions analysis was performed. We used a forward stepwise selection process for our final multivariable model. RESULTS AND LIMITATIONS: Within a median follow-up of 18 mo, 266 patients died of disease. Cancer-specific survival at 1 yr was 79%, 76%, and 47% for patients with no (n=105), one (n=180), and two (n=87) risk factors (p<0.001; c-index: 0.604). On multivariable analyses, we found that KPS <80%, higher American Society of Anesthesiologists score, anemia, leukocytosis, and shorter time to DR (all p values <0.034) were independently associated with increased CSM. The combination of time to DR and KPS resulted in improved discrimination (c-index: 0.694). CONCLUSIONS: We confirmed the prognostic value of KPS and VMs in patients with DR following RC for UCB. We also found several other clinical variables to be associated with worse CSM. We developed a model for predicting survival after DR inclusive of time to DR and KPS assessed at DR. If validated, this model could help clinical trial design. PATIENT SUMMARY: We developed a model to predict survival following disease recurrence after radical cystectomy for urothelial carcinoma of the bladder, based on time to disease recurrence and Karnofsky performance status. |
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Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved. |
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KEYWORDS: Bladder cancer, Disease recurrence, Metastasis, Model, Prognosis, Survival, Transitional cell carcinoma, Urothelial carcinoma of the bladder |
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Publikations ID: 28723361 Quelle: öffnen |
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