Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder
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Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder. / Novotny, Vladimir; Froehner, Michael; May, Matthias; Protzel, Chris; Hergenröther, Katrin; Rink, Michael; Chun, Felix K; Fisch, Margit; Roghmann, Florian; Palisaar, Rein-Jüri; Noldus, Joachim; Gierth, Michael; Fritsche, Hans-Martin; Burger, Maximilian; Sikic, Danijel; Keck, Bastian; Wullich, Bernd; Nuhn, Philipp; Buchner, Alexander; Stief, Christian G; Vallo, Stefan; Bartsch, Georg; Haferkamp, Axel; Bastian, Patrick J; Hakenberg, Oliver W; Propping, Stefan; Aziz, Atiqullah.
In: WORLD J UROL, Vol. 33, No. 11, 08.02.2015, p. 1753-1761.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder
AU - Novotny, Vladimir
AU - Froehner, Michael
AU - May, Matthias
AU - Protzel, Chris
AU - Hergenröther, Katrin
AU - Rink, Michael
AU - Chun, Felix K
AU - Fisch, Margit
AU - Roghmann, Florian
AU - Palisaar, Rein-Jüri
AU - Noldus, Joachim
AU - Gierth, Michael
AU - Fritsche, Hans-Martin
AU - Burger, Maximilian
AU - Sikic, Danijel
AU - Keck, Bastian
AU - Wullich, Bernd
AU - Nuhn, Philipp
AU - Buchner, Alexander
AU - Stief, Christian G
AU - Vallo, Stefan
AU - Bartsch, Georg
AU - Haferkamp, Axel
AU - Bastian, Patrick J
AU - Hakenberg, Oliver W
AU - Propping, Stefan
AU - Aziz, Atiqullah
PY - 2015/2/8
Y1 - 2015/2/8
N2 - PURPOSE: To externally validate the Christodouleas risk model incorporating pathological tumor stage, lymph node (LN) count and soft tissue surgical margin (STSM) and stratifying patients who develop locoregional recurrence (LR) after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). In addition, we aimed to generate a new model including established clinicopathological features that were absent in the Christodouleas risk model.METHODS: Prospectively assessed multicenter data from 565 patients undergoing RC for UCB in 2011 qualified for final analysis. For the purpose of external validation, risk group stratification according to Christodouleas was performed. Competing-risk models were calculated to compare the cumulative incidences of LR after RC.RESULTS: After a median follow-up of 25 months (interquartile range 19-29), the LR-rate was 11.5 %. The Christodouleas model showed a predictive accuracy of 83.2 % in our cohort. In multivariable competing-risk analysis, tumor stage ≥pT3 (HR 4.32, p < 0.001), positive STSM (HR 2.93, p = 0.005), lymphovascular invasion (HR 3.41, p < 0.001), the number of removed LNs <10 (HR 2.62, p < 0.001) and the administration of adjuvant chemotherapy (HR 0.40, p = 0.008) independently predicted the LR-rate. The resulting risk groups revealed significant differences in LR-rates after 24 months with 4.8 % for low-risk patients, 14.7 % for intermediate-risk patients and 38.9 % for high-risk patients (p < 0.001 for all), with a predictive accuracy of 85.6 %, respectively.CONCLUSIONS: The Christodouleas risk model has been successfully externally validated in the present prospective series. However, this analysis finds that overall model performance may be improved by incorporating lymphovascular invasion. After external validation of the newly proposed risk model, it may be used to identify patients who benefit from an adjuvant therapy and suit for inclusion in clinical trials.
AB - PURPOSE: To externally validate the Christodouleas risk model incorporating pathological tumor stage, lymph node (LN) count and soft tissue surgical margin (STSM) and stratifying patients who develop locoregional recurrence (LR) after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). In addition, we aimed to generate a new model including established clinicopathological features that were absent in the Christodouleas risk model.METHODS: Prospectively assessed multicenter data from 565 patients undergoing RC for UCB in 2011 qualified for final analysis. For the purpose of external validation, risk group stratification according to Christodouleas was performed. Competing-risk models were calculated to compare the cumulative incidences of LR after RC.RESULTS: After a median follow-up of 25 months (interquartile range 19-29), the LR-rate was 11.5 %. The Christodouleas model showed a predictive accuracy of 83.2 % in our cohort. In multivariable competing-risk analysis, tumor stage ≥pT3 (HR 4.32, p < 0.001), positive STSM (HR 2.93, p = 0.005), lymphovascular invasion (HR 3.41, p < 0.001), the number of removed LNs <10 (HR 2.62, p < 0.001) and the administration of adjuvant chemotherapy (HR 0.40, p = 0.008) independently predicted the LR-rate. The resulting risk groups revealed significant differences in LR-rates after 24 months with 4.8 % for low-risk patients, 14.7 % for intermediate-risk patients and 38.9 % for high-risk patients (p < 0.001 for all), with a predictive accuracy of 85.6 %, respectively.CONCLUSIONS: The Christodouleas risk model has been successfully externally validated in the present prospective series. However, this analysis finds that overall model performance may be improved by incorporating lymphovascular invasion. After external validation of the newly proposed risk model, it may be used to identify patients who benefit from an adjuvant therapy and suit for inclusion in clinical trials.
U2 - 10.1007/s00345-015-1502-y
DO - 10.1007/s00345-015-1502-y
M3 - SCORING: Journal article
C2 - 25663359
VL - 33
SP - 1753
EP - 1761
JO - WORLD J UROL
JF - WORLD J UROL
SN - 0724-4983
IS - 11
ER -