Development of a prediction tool for exclusive locoregional recurrence after radical cystectomy in patients with muscle-invasive bladder cancer Journal Article

Authors: Necchi, A.; Pond, G. R.; Moschini, M.; Plimack, E. R.; Niegisch, G.; Yu, E. Y.; Bamias, A.; Agarwal, N.; Vaishampayan, U.; Theodore, C.; Sridhar, S. S.; Rosenberg, J. E.; Bellmunt, J.; Gallina, A.; Colombo, R.; Montorsi, F.; Briganti, A.; Galsky, M. D.
Article Title: Development of a prediction tool for exclusive locoregional recurrence after radical cystectomy in patients with muscle-invasive bladder cancer
Abstract: Background: Limited information is available about the pattern of relapse after perioperative chemotherapy with radical cystectomy (RC) vs. RC alone in muscle-invasive bladder cancer. Patients and Methods: Data from 1082 patients of the Retrospective International Study of Invasive/Advanced Cancer of the Urothelium database, treated from February 1990 to December 2013 at 27 centers in the United States, Europe, Israel, and Canada, were collected. Locoregional relapse was defined as any pelvic lymph node or soft tissue-only recurrences. Cumulative incidence methods were used to estimate time to locoregional relapse (TTRL). Cox regression analyses were performed and a nomogram for 12-month locoregional relapse-free survival (RFS) was developed. The nomogram was applied to an external data set (n = 1021). Results: A total of 517 patients (47.8%) developed a relapse: 177 (16.4%) exclusive locoregional relapse. In multivariable analyses, perioperative chemotherapy was associated with longer TTRL (P <.001). Other factors were nonurothelial histology (P =.013), pT-stage (P <.001), and surgical margins (P <.001). The concordance index of the model was 0.681 (95% bootstrapped confidence interval, 0.666-0.716). Risk group categories were obtained according to nomogram tertiles. Despite, overall, observed locoregional RFS in the validation cohort exceeding predicted results, for high-risk patients (80 points or less, lowest nomogram tertile) observed 12-month RFS was similar between development and validation cohorts (60.1% and 66.6%). The study is limited by its retrospective nature. Conclusion: In the largest study, to our knowledge, that analyzed locoregional recurrences after RC, we propose a risk prediction tool for exclusive locoregional failures that might be suitable for clinical studies. Patients best suited for adjuvant radiotherapy might be those within the lowest nomogram tertile. Prospective trials are needed to validate findings. © 2018 Elsevier Inc. We analyzed prognostic factors and developed a prediction tool for exclusive locoregional (pelvic) recurrences after radical cystectomy for bladder cancer. We identified a subgroup of patients with the highest risk who might be best suited for clinical studies. © 2018 Elsevier Inc.
Keywords: adult; cancer survival; aged; major clinical study; cancer patient; chemotherapy; cancer incidence; pelvis lymph node; bladder cancer; prediction; histology; high risk patient; risk assessment; cystectomy; urothelial carcinoma; recurrent disease; perioperative period; high risk population; perioperative chemotherapy; adjuvant radiotherapy; nomogram; surgical margin; muscle invasive bladder cancer; risk prediction; local recurrence free survival; human; male; female; article
Journal Title: Clinical Genitourinary Cancer
Volume: 17
Issue: 1
ISSN: 1558-7673
Publisher: Elsevier Inc.  
Date Published: 2019-02-01
Start Page: 7
End Page: 14.e3
Language: English
DOI: 10.1016/j.clgc.2018.09.008
PUBMED: 30292628
PROVIDER: scopus
Notes: Export Date: 1 February 2019 -- Source: Scopus
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  1. Jonathan Eric Rosenberg
    225 Rosenberg