Prognostic Role of Preoperative Vascular Cell Adhesion Molecule-1 Plasma Levels in Urothelial Carcinoma of the Bladder Treated With Radical Cystectomy

TY - JOUR

T1 - Prognostic Role of Preoperative Vascular Cell Adhesion Molecule-1 Plasma Levels in Urothelial Carcinoma of the Bladder Treated With Radical Cystectomy

AU - Mori, Keiichiro

AU - Schuettfort, Victor M

AU - Katayama, Satoshi

AU - Laukhtina, Ekaterina

AU - Pradere, Benjamin

AU - Quhal, Fahad

AU - Sari Motlagh, Reza

AU - Mostafaei, Hadi

AU - Grossmann, Nico C

AU - Rajwa, Pawel

AU - Teoh, Jeremy Yc

AU - Resch, Irene

AU - Fajkovic, Harun

AU - Moschini, Marco

AU - D'andrea, David

AU - Abufaraj, Mohammad

AU - Karakiewicz, Pierre I

AU - Lotan, Yair

AU - Scherr, Douglas

AU - Egawa, Shin

AU - Compérat, Eva

AU - Shariat, Shahrokh F

AU - European Association of Urology – Young Academic Urologists (EAU-YAU), Urothelial Carcinoma Working Group

N1 - © 2022. The Author(s).

PY - 2022/8

Y1 - 2022/8

N2 - BACKGROUND: Angiogenesis-related marker vascular cell adhesion molecule-1 (VCAM-1) has been shown to be elevated in urothelial carcinoma of the bladder (UCB), but its predictive/prognostic role has not been determined. Thus, this study aimed to investigate the predictive/prognostic role of VCAM-1 for patients who have UCB treated with radical cystectomy (RC).METHODS: The study enrolled 1036 patients with clinically non-metastatic advanced UCB who underwent RC, and plasma VCAM-1 was evaluated preoperatively. The correlation of plasma VCAM-1 with pathologic and survival outcomes was assessed using binominal logistic regression and multivariable Cox regression analyses. Discrimination was assessed using the area under the curve and concordance indices. The clinical net benefit was evaluated using decision curve analysis (DCA).RESULTS: Preoperative VCAM-1 was significantly elevated in patients with adverse pathologic features. Higher VCAM-1 levels were independently associated with increased risk of lymph-node-metastasis (LNM), ≥pT3 disease, and non-organ-confined disease (NOCD (p < 0.001 for each). Preoperative plasma VCAM-1 was independently associated with recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in pre- and postoperative multivariable models. Adding VCAM-1 to these predictive models improved their discriminatory ability to predict all outcomes by a significant margin. In the DCA, VCAM-1 addition to the reference models for prediction of LNM, NOCD, RFS, and CSS resulted in relevant improvement.CONCLUSIONS: Elevated plasma VCAM-1 was associated with biologically and clinically aggressive UCB disease features. After validation, preoperative VCAM-1 may serve as a biomarker to help identify patients likely to benefit from intensified/multimodal therapy. In addition, VCAM-1 improved the discriminatory power of predictive/prognostic models and can be used to refine personalized clinical decision-making.

AB - BACKGROUND: Angiogenesis-related marker vascular cell adhesion molecule-1 (VCAM-1) has been shown to be elevated in urothelial carcinoma of the bladder (UCB), but its predictive/prognostic role has not been determined. Thus, this study aimed to investigate the predictive/prognostic role of VCAM-1 for patients who have UCB treated with radical cystectomy (RC).METHODS: The study enrolled 1036 patients with clinically non-metastatic advanced UCB who underwent RC, and plasma VCAM-1 was evaluated preoperatively. The correlation of plasma VCAM-1 with pathologic and survival outcomes was assessed using binominal logistic regression and multivariable Cox regression analyses. Discrimination was assessed using the area under the curve and concordance indices. The clinical net benefit was evaluated using decision curve analysis (DCA).RESULTS: Preoperative VCAM-1 was significantly elevated in patients with adverse pathologic features. Higher VCAM-1 levels were independently associated with increased risk of lymph-node-metastasis (LNM), ≥pT3 disease, and non-organ-confined disease (NOCD (p < 0.001 for each). Preoperative plasma VCAM-1 was independently associated with recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in pre- and postoperative multivariable models. Adding VCAM-1 to these predictive models improved their discriminatory ability to predict all outcomes by a significant margin. In the DCA, VCAM-1 addition to the reference models for prediction of LNM, NOCD, RFS, and CSS resulted in relevant improvement.CONCLUSIONS: Elevated plasma VCAM-1 was associated with biologically and clinically aggressive UCB disease features. After validation, preoperative VCAM-1 may serve as a biomarker to help identify patients likely to benefit from intensified/multimodal therapy. In addition, VCAM-1 improved the discriminatory power of predictive/prognostic models and can be used to refine personalized clinical decision-making.

KW - Carcinoma, Transitional Cell/pathology

KW - Cystectomy

KW - Humans

KW - Lymphatic Metastasis

KW - Prognosis

KW - Retrospective Studies

KW - Treatment Outcome

KW - Urinary Bladder/pathology

KW - Urinary Bladder Neoplasms/pathology

KW - Vascular Cell Adhesion Molecule-1

U2 - 10.1245/s10434-022-11575-4

DO - 10.1245/s10434-022-11575-4

M3 - SCORING: Journal article

C2 - 35347517

VL - 29

SP - 5307

EP - 5316

JO - ANN SURG ONCOL

JF - ANN SURG ONCOL

SN - 1068-9265

IS - 8

ER -