Novotny, Vladimir and Froehner, Michael and May, Matthias and Protzel, Chris and Hergenroether, Katrin and Rink, Michael and Chun, Felix K. and Fisch, Margit and Roghmann, Florian and Palisaar, Rein-Juri and Noldus, Joachim and Gierth, Michael and Fritsche, Hans-Martin and Burger, Maximilian and Sikic, Danijel and Keck, Bastian and Wullich, Bernd and Nuhn, Philipp and Buchner, Alexander and Stief, Christian G. and Vallo, Stefan and Bartsch, Georg and Haferkamp, Axel and Bastian, Patrick J. and Hakenberg, Oliver W. and Propping, Stefan and Aziz, Atiqullah (2015) Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder. WORLD JOURNAL OF UROLOGY, 33 (11). pp. 1753-1761. ISSN 0724-4983, 1433-8726
Full text not available from this repository. (Request a copy)Abstract
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. 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. 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 a parts per thousand yenpT3 (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. 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | LYMPHOVASCULAR INVASION; LOCAL RECURRENCE; CANCER; SURVIVAL; CHEMOTHERAPY; PREDICTORS; NEOADJUVANT; MORTALITY; Bladder cancer; Radical cystectomy; Recurrence; Outcome |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 07 May 2019 13:52 |
| Last Modified: | 07 May 2019 13:52 |
| URI: | https://pred.uni-regensburg.de/id/eprint/4555 |
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