You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111418 PROGNOSTIC TOOL TO HELP IDENTIFY PT1-3N0 PATIENTS LIKELY TO BENEFIT FROM ADJUVANT CHEMOTHERAPY AFTER RADICAL CYSTECTOMY Eugene Cha, Thomas Chromecki, Maxine Sun, Robert Svatek, Michael Rink, Mesut Remzi, Yair Lotan, Giacomo Novara, Christian Seitz, Felix Chun, Richard Lee, Karl Pummer, Armin Pycha, Wassim Kassouf, Vincenzo Ficarra, Douglas Scherr, Pierre Karakiewicz, and Shahrokh Shariat Eugene ChaEugene Cha New York, NY More articles by this author , Thomas ChromeckiThomas Chromecki New York, NY More articles by this author , Maxine SunMaxine Sun Montreal, Canada More articles by this author , Robert SvatekRobert Svatek San Antonio, TX More articles by this author , Michael RinkMichael Rink Hamburg, Germany More articles by this author , Mesut RemziMesut Remzi Vienna, Austria More articles by this author , Yair LotanYair Lotan Dallas, TX More articles by this author , Giacomo NovaraGiacomo Novara Padua, Italy More articles by this author , Christian SeitzChristian Seitz Bolzano, Italy More articles by this author , Felix ChunFelix Chun Hamburg, Germany More articles by this author , Richard LeeRichard Lee New York, NY More articles by this author , Karl PummerKarl Pummer Graz, Austria More articles by this author , Armin PychaArmin Pycha Bolzano, Italy More articles by this author , Wassim KassoufWassim Kassouf Montreal, Canada More articles by this author , Vincenzo FicarraVincenzo Ficarra Padua, Italy More articles by this author , Douglas ScherrDouglas Scherr New York, NY More articles by this author , Pierre KarakiewiczPierre Karakiewicz Montreal, Canada More articles by this author , and Shahrokh ShariatShahrokh Shariat New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1309AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with pT4 disease and/or lymph node involvement are usually counseled in favor of adjuvant chemotherapy after radical cystectomy. However, the majority of patients have pT1-T3N0 disease. Given heterogeneous outcomes, they are infrequently provided with multi-modal therapy. The aim of the current study was to develop a prognostic tool to guide clinical decision-making regarding observation versus adjuvant therapy in pT1-3N0 patients. METHODS We reviewed the records of 2,145 patients who had pT1-3N0 urothelial carcinoma of the bladder after radical cystectomy. None of the patients received neoadjuvant or adjuvant chemotherapy. Predictors included pT stage, lymphovascular invasion, soft tissue surgical margin, grade, number of nodes removed, concomitant CIS, age, and gender. The cohort was randomly split into a development cohort (n=1067) and a validation cohort (n=1078). Predictive accuracy was quantified using the concordance index. Median follow-up was 46 months. RESULTS Five-year recurrence-free and cancer-specific survival estimates were 68% (SE 1) and 73% (SE 1), respectively. In univariate analyses, higher pT stage, lymphovascular invasion, positive soft tissue surgical margin, grade, and age were significantly associated with both disease recurrence and cancer-specific mortality (p values ≤ 0.04). In multivariable analysis, pT stage, 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. CONCLUSIONS Despite apparent cure with extirpative surgery, a significant number of patients with pT1-3N0 experience recurrence and ultimately die of disease. However, the oncologic outcomes of these patients can be predicted with reasonable accuracy. We have developed and externally validated competing-risk, conditional probability nomograms that predict the risks of cancer recurrence and survival for pT1-3N0 patients after radical cystectomy. These nomograms may improve the decision-making process regarding adjuvant chemotherapy. In addition, such prediction tools may assist in the development of entry criteria for clinical trials. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e568 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Cha New York, NY More articles by this author Thomas Chromecki New York, NY More articles by this author Maxine Sun Montreal, Canada More articles by this author Robert Svatek San Antonio, TX More articles by this author Michael Rink Hamburg, Germany More articles by this author Mesut Remzi Vienna, Austria More articles by this author Yair Lotan Dallas, TX More articles by this author Giacomo Novara Padua, Italy More articles by this author Christian Seitz Bolzano, Italy More articles by this author Felix Chun Hamburg, Germany More articles by this author Richard Lee New York, NY More articles by this author Karl Pummer Graz, Austria More articles by this author Armin Pycha Bolzano, Italy More articles by this author Wassim Kassouf Montreal, Canada More articles by this author Vincenzo Ficarra Padua, Italy More articles by this author Douglas Scherr New York, NY More articles by this author Pierre Karakiewicz Montreal, Canada More articles by this author Shahrokh Shariat New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
