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Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy

Standard

Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy. / Green, David A; Rink, Michael; Hansen, Jens; Cha, Eugene K; Robinson, Brian; Tian, Zhe; Chun, Felix K; Tagawa, Scott; Karakiewicz, Pierre I; Fisch, Margit; Scherr, Douglas S; Shariat, Shahrokh F.

in: BJU INT, Jahrgang 111, Nr. 3, 01.03.2013, S. 404-11.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Green, DA, Rink, M, Hansen, J, Cha, EK, Robinson, B, Tian, Z, Chun, FK, Tagawa, S, Karakiewicz, PI, Fisch, M, Scherr, DS & Shariat, SF 2013, 'Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy', BJU INT, Jg. 111, Nr. 3, S. 404-11. https://doi.org/10.1111/j.1464-410X.2012.11370.x

APA

Green, D. A., Rink, M., Hansen, J., Cha, E. K., Robinson, B., Tian, Z., Chun, F. K., Tagawa, S., Karakiewicz, P. I., Fisch, M., Scherr, D. S., & Shariat, S. F. (2013). Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy. BJU INT, 111(3), 404-11. https://doi.org/10.1111/j.1464-410X.2012.11370.x

Vancouver

Green DA, Rink M, Hansen J, Cha EK, Robinson B, Tian Z et al. Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy. BJU INT. 2013 Mär 1;111(3):404-11. https://doi.org/10.1111/j.1464-410X.2012.11370.x

Bibtex

@article{b160ed71a6914739869ab126f48e08af,
title = "Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy",
abstract = "UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Upstaging to non-organ-confined (NOC) disease is frequent at the time of radical cystectomy for urothelial carcinoma of the bladder (UCB). Pre-surgical models that can accurately predict which patients are likely to have more extensive disease are sparse. The present study developed an accurate nomogram for the prediction of NOC-UCB based on a cohort of patients with clinically organ-confined disease. Adoption of such a tool into daily clinical decision-making may lead to more appropriate integration of perioperative chemotherapy, thereby potentially improving survival in patients with UCB.OBJECTIVE: To create an accurate pre-cystectomy decision-making tool that allows for the accurate identification of patients with clinically organ-confined urothelial carcinoma of the bladder (UCB) who have non-organ-confined UCB (NOC-UCB) at cystectomy, as identification of patients with UCB most likely to benefit from neoadjuvant chemotherapy (NACTx) is hampered by inaccurate clinical staging.PATIENTS AND METHODS: A prospectively maintained single-institution database containing 201 patients who underwent cystectomy and pelvic lymph node (LN) dissection without NACTx for UCB was analysed. Predictive variables for NOC-UCB included, among others, age, gender, transurethral resection of bladder tumour (TURBT) findings (stage, grade, histology, size, presence of carcinoma in situ, lymphovascular invasion [LVI], multifocality), history of intravesical therapy, time from TURBT to cystectomy, and cross-sectional imaging findings.RESULTS: Clinical stage distribution was 19 patients with Ta, 15 with Tis, 67 with T1, and 100 with T2. At the time of cystectomy, NOC-UCB and LN-positive disease were found in 71 (35%) and 38 (19%) of patients, respectively; 81 (40%) of patients had NOC-UCB (≥pT3/Nany or pTany/N+). Tumour stage (P [trend] <0.001), presence of LVI (odds ratio [OR] 5.2; P = 0.02), and radiographic evidence of NOC-UCB or hydronephrosis (OR 3.2; P = 0.01) were independently associated with ≥pT3 Nany UCB. Tumour stage (P [trend] < 0.001) and presence of LVI (OR 6.64; P = 0.01) were independently associated with (≥pT3/Nany or pTany/N+) UCB. A nomogram to predict (≥pT3/Nany or pTany/N+) based on all three variables was highly accurate (area under the curve 0.828) and well calibrated, deviating <8% from ideal prediction. Decision curve analysis showed net benefit across all threshold probabilities.CONCLUSIONS: NOC-UCB can be predicted with high accuracy by integrating standard clinicopathological factors with imaging information. This model may help to identify patients with NOC-UCB who may benefit from NACTx.",
keywords = "Adult, Aged, Aged, 80 and over, Cystectomy, Female, Humans, Male, Middle Aged, Models, Biological, Nomograms, Preoperative Period, Prognosis, Prospective Studies, Retrospective Studies, Risk Factors, Urinary Bladder Neoplasms, Urothelium",
author = "Green, {David A} and Michael Rink and Jens Hansen and Cha, {Eugene K} and Brian Robinson and Zhe Tian and Chun, {Felix K} and Scott Tagawa and Karakiewicz, {Pierre I} and Margit Fisch and Scherr, {Douglas S} and Shariat, {Shahrokh F}",
note = "{\textcopyright} 2012 BJU International.",
year = "2013",
month = mar,
day = "1",
doi = "10.1111/j.1464-410X.2012.11370.x",
language = "English",
volume = "111",
pages = "404--11",
journal = "BJU INT",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "3",

}

RIS

TY - JOUR

T1 - Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy

AU - Green, David A

AU - Rink, Michael

AU - Hansen, Jens

AU - Cha, Eugene K

AU - Robinson, Brian

AU - Tian, Zhe

AU - Chun, Felix K

AU - Tagawa, Scott

AU - Karakiewicz, Pierre I

AU - Fisch, Margit

AU - Scherr, Douglas S

AU - Shariat, Shahrokh F

N1 - © 2012 BJU International.

PY - 2013/3/1

Y1 - 2013/3/1

N2 - UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Upstaging to non-organ-confined (NOC) disease is frequent at the time of radical cystectomy for urothelial carcinoma of the bladder (UCB). Pre-surgical models that can accurately predict which patients are likely to have more extensive disease are sparse. The present study developed an accurate nomogram for the prediction of NOC-UCB based on a cohort of patients with clinically organ-confined disease. Adoption of such a tool into daily clinical decision-making may lead to more appropriate integration of perioperative chemotherapy, thereby potentially improving survival in patients with UCB.OBJECTIVE: To create an accurate pre-cystectomy decision-making tool that allows for the accurate identification of patients with clinically organ-confined urothelial carcinoma of the bladder (UCB) who have non-organ-confined UCB (NOC-UCB) at cystectomy, as identification of patients with UCB most likely to benefit from neoadjuvant chemotherapy (NACTx) is hampered by inaccurate clinical staging.PATIENTS AND METHODS: A prospectively maintained single-institution database containing 201 patients who underwent cystectomy and pelvic lymph node (LN) dissection without NACTx for UCB was analysed. Predictive variables for NOC-UCB included, among others, age, gender, transurethral resection of bladder tumour (TURBT) findings (stage, grade, histology, size, presence of carcinoma in situ, lymphovascular invasion [LVI], multifocality), history of intravesical therapy, time from TURBT to cystectomy, and cross-sectional imaging findings.RESULTS: Clinical stage distribution was 19 patients with Ta, 15 with Tis, 67 with T1, and 100 with T2. At the time of cystectomy, NOC-UCB and LN-positive disease were found in 71 (35%) and 38 (19%) of patients, respectively; 81 (40%) of patients had NOC-UCB (≥pT3/Nany or pTany/N+). Tumour stage (P [trend] <0.001), presence of LVI (odds ratio [OR] 5.2; P = 0.02), and radiographic evidence of NOC-UCB or hydronephrosis (OR 3.2; P = 0.01) were independently associated with ≥pT3 Nany UCB. Tumour stage (P [trend] < 0.001) and presence of LVI (OR 6.64; P = 0.01) were independently associated with (≥pT3/Nany or pTany/N+) UCB. A nomogram to predict (≥pT3/Nany or pTany/N+) based on all three variables was highly accurate (area under the curve 0.828) and well calibrated, deviating <8% from ideal prediction. Decision curve analysis showed net benefit across all threshold probabilities.CONCLUSIONS: NOC-UCB can be predicted with high accuracy by integrating standard clinicopathological factors with imaging information. This model may help to identify patients with NOC-UCB who may benefit from NACTx.

AB - UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Upstaging to non-organ-confined (NOC) disease is frequent at the time of radical cystectomy for urothelial carcinoma of the bladder (UCB). Pre-surgical models that can accurately predict which patients are likely to have more extensive disease are sparse. The present study developed an accurate nomogram for the prediction of NOC-UCB based on a cohort of patients with clinically organ-confined disease. Adoption of such a tool into daily clinical decision-making may lead to more appropriate integration of perioperative chemotherapy, thereby potentially improving survival in patients with UCB.OBJECTIVE: To create an accurate pre-cystectomy decision-making tool that allows for the accurate identification of patients with clinically organ-confined urothelial carcinoma of the bladder (UCB) who have non-organ-confined UCB (NOC-UCB) at cystectomy, as identification of patients with UCB most likely to benefit from neoadjuvant chemotherapy (NACTx) is hampered by inaccurate clinical staging.PATIENTS AND METHODS: A prospectively maintained single-institution database containing 201 patients who underwent cystectomy and pelvic lymph node (LN) dissection without NACTx for UCB was analysed. Predictive variables for NOC-UCB included, among others, age, gender, transurethral resection of bladder tumour (TURBT) findings (stage, grade, histology, size, presence of carcinoma in situ, lymphovascular invasion [LVI], multifocality), history of intravesical therapy, time from TURBT to cystectomy, and cross-sectional imaging findings.RESULTS: Clinical stage distribution was 19 patients with Ta, 15 with Tis, 67 with T1, and 100 with T2. At the time of cystectomy, NOC-UCB and LN-positive disease were found in 71 (35%) and 38 (19%) of patients, respectively; 81 (40%) of patients had NOC-UCB (≥pT3/Nany or pTany/N+). Tumour stage (P [trend] <0.001), presence of LVI (odds ratio [OR] 5.2; P = 0.02), and radiographic evidence of NOC-UCB or hydronephrosis (OR 3.2; P = 0.01) were independently associated with ≥pT3 Nany UCB. Tumour stage (P [trend] < 0.001) and presence of LVI (OR 6.64; P = 0.01) were independently associated with (≥pT3/Nany or pTany/N+) UCB. A nomogram to predict (≥pT3/Nany or pTany/N+) based on all three variables was highly accurate (area under the curve 0.828) and well calibrated, deviating <8% from ideal prediction. Decision curve analysis showed net benefit across all threshold probabilities.CONCLUSIONS: NOC-UCB can be predicted with high accuracy by integrating standard clinicopathological factors with imaging information. This model may help to identify patients with NOC-UCB who may benefit from NACTx.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cystectomy

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Models, Biological

KW - Nomograms

KW - Preoperative Period

KW - Prognosis

KW - Prospective Studies

KW - Retrospective Studies

KW - Risk Factors

KW - Urinary Bladder Neoplasms

KW - Urothelium

U2 - 10.1111/j.1464-410X.2012.11370.x

DO - 10.1111/j.1464-410X.2012.11370.x

M3 - SCORING: Journal article

C2 - 22805163

VL - 111

SP - 404

EP - 411

JO - BJU INT

JF - BJU INT

SN - 1464-4096

IS - 3

ER -