Prognostic risk stratification of pathological stage T3N0 bladder cancer after radical cystectomy

Guru Sonpavde, Myrna M. Khan, Robert Svatek, Richard Lee, Giacomo Novara, Derya Tilki, Seth P. Lerner, Gilad E. Amiel, Eila Skinner, Pierre I. Karakiewicz, Patrick J. Bastian, Wassim Kassouf, Hans Martin Fritsche, Jonathan I. Izawa, Douglas S. Scherr, Vincenzo Ficarra, Colin P. Dinney, Yair Lotan, Yves Fradet, Shahrokh F. Shariat

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Purpose: Patients with pathological T3N0 stage urothelial carcinoma of the bladder show a range of outcomes after radical cystectomy. Given that nomograms have included heterogeneous groups of patients, we focused on and stratified patients with pT3N0 urothelial carcinoma of the bladder after radical cystectomy into prognostically different risk groups to facilitate the development of adjuvant therapy trials for those at high risk. Materials and Methods: The study comprised a total of 578 patients from 9 centers worldwide with pT3N0 urothelial carcinoma of the bladder who underwent radical cystectomy without perioperative chemotherapy. We evaluated the effect of pT3 substage at radical cystectomy, age, grade, lymphovascular invasion, margin status and number of lymph nodes removed on recurrence-free survival using Cox regression analysis. A weighted prognostic model was devised. Results: Median followup was 39.4 months (IQR 64). On multivariate analysis pT3 substage at radical cystectomy (pT3b vs pT3a HR 2.056, p <0.0001), lymphovascular invasion (positive vs negative HR 2.004, p <0.0001) and margin status (positive vs negative HR 2.503, p = 0.002) were associated with recurrence-free survival (concordance index 0.66) in the context of generally adequate lymph node dissection, that is with a median of 17 removed. Three risk groups were devised based on weighted variables with a 5-year recurrence-free survival rate of 79% (95% CI 70-84), 57% (95% CI 50-64) and 37% (95% CI 26-48) in the low, intermediate and high risk groups, respectively. Conclusions: We constructed a user friendly prognostic risk model for patients with pT3N0 urothelial carcinoma of the bladder treated with radical cystectomy based on pT3 substage at radical cystectomy, lymphovascular invasion and margin status. These data warrant validation and may enable tailored monitoring and selection of appropriate patients for adjuvant therapy trials.

Original languageEnglish (US)
Pages (from-to)1216-1221
Number of pages6
JournalJournal of Urology
Volume185
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

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Cystectomy
Urinary Bladder Neoplasms
Urinary Bladder
Carcinoma
Recurrence
Nomograms
Survival
Lymph Node Excision
Patient Selection
Multivariate Analysis
Survival Rate
Lymph Nodes
Regression Analysis
Drug Therapy
Therapeutics

Keywords

  • carcinoma
  • cystectomy
  • risk
  • urinary bladder
  • urothelium

ASJC Scopus subject areas

  • Urology

Cite this

Prognostic risk stratification of pathological stage T3N0 bladder cancer after radical cystectomy. / Sonpavde, Guru; Khan, Myrna M.; Svatek, Robert; Lee, Richard; Novara, Giacomo; Tilki, Derya; Lerner, Seth P.; Amiel, Gilad E.; Skinner, Eila; Karakiewicz, Pierre I.; Bastian, Patrick J.; Kassouf, Wassim; Fritsche, Hans Martin; Izawa, Jonathan I.; Scherr, Douglas S.; Ficarra, Vincenzo; Dinney, Colin P.; Lotan, Yair; Fradet, Yves; Shariat, Shahrokh F.

In: Journal of Urology, Vol. 185, No. 4, 04.2011, p. 1216-1221.

Research output: Contribution to journalArticle

Sonpavde, G, Khan, MM, Svatek, R, Lee, R, Novara, G, Tilki, D, Lerner, SP, Amiel, GE, Skinner, E, Karakiewicz, PI, Bastian, PJ, Kassouf, W, Fritsche, HM, Izawa, JI, Scherr, DS, Ficarra, V, Dinney, CP, Lotan, Y, Fradet, Y & Shariat, SF 2011, 'Prognostic risk stratification of pathological stage T3N0 bladder cancer after radical cystectomy', Journal of Urology, vol. 185, no. 4, pp. 1216-1221. https://doi.org/10.1016/j.juro.2010.11.082
Sonpavde, Guru ; Khan, Myrna M. ; Svatek, Robert ; Lee, Richard ; Novara, Giacomo ; Tilki, Derya ; Lerner, Seth P. ; Amiel, Gilad E. ; Skinner, Eila ; Karakiewicz, Pierre I. ; Bastian, Patrick J. ; Kassouf, Wassim ; Fritsche, Hans Martin ; Izawa, Jonathan I. ; Scherr, Douglas S. ; Ficarra, Vincenzo ; Dinney, Colin P. ; Lotan, Yair ; Fradet, Yves ; Shariat, Shahrokh F. / Prognostic risk stratification of pathological stage T3N0 bladder cancer after radical cystectomy. In: Journal of Urology. 2011 ; Vol. 185, No. 4. pp. 1216-1221.
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abstract = "Purpose: Patients with pathological T3N0 stage urothelial carcinoma of the bladder show a range of outcomes after radical cystectomy. Given that nomograms have included heterogeneous groups of patients, we focused on and stratified patients with pT3N0 urothelial carcinoma of the bladder after radical cystectomy into prognostically different risk groups to facilitate the development of adjuvant therapy trials for those at high risk. Materials and Methods: The study comprised a total of 578 patients from 9 centers worldwide with pT3N0 urothelial carcinoma of the bladder who underwent radical cystectomy without perioperative chemotherapy. We evaluated the effect of pT3 substage at radical cystectomy, age, grade, lymphovascular invasion, margin status and number of lymph nodes removed on recurrence-free survival using Cox regression analysis. A weighted prognostic model was devised. Results: Median followup was 39.4 months (IQR 64). On multivariate analysis pT3 substage at radical cystectomy (pT3b vs pT3a HR 2.056, p <0.0001), lymphovascular invasion (positive vs negative HR 2.004, p <0.0001) and margin status (positive vs negative HR 2.503, p = 0.002) were associated with recurrence-free survival (concordance index 0.66) in the context of generally adequate lymph node dissection, that is with a median of 17 removed. Three risk groups were devised based on weighted variables with a 5-year recurrence-free survival rate of 79{\%} (95{\%} CI 70-84), 57{\%} (95{\%} CI 50-64) and 37{\%} (95{\%} CI 26-48) in the low, intermediate and high risk groups, respectively. Conclusions: We constructed a user friendly prognostic risk model for patients with pT3N0 urothelial carcinoma of the bladder treated with radical cystectomy based on pT3 substage at radical cystectomy, lymphovascular invasion and margin status. These data warrant validation and may enable tailored monitoring and selection of appropriate patients for adjuvant therapy trials.",
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author = "Guru Sonpavde and Khan, {Myrna M.} and Robert Svatek and Richard Lee and Giacomo Novara and Derya Tilki and Lerner, {Seth P.} and Amiel, {Gilad E.} and Eila Skinner and Karakiewicz, {Pierre I.} and Bastian, {Patrick J.} and Wassim Kassouf and Fritsche, {Hans Martin} and Izawa, {Jonathan I.} and Scherr, {Douglas S.} and Vincenzo Ficarra and Dinney, {Colin P.} and Yair Lotan and Yves Fradet and Shariat, {Shahrokh F.}",
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T1 - Prognostic risk stratification of pathological stage T3N0 bladder cancer after radical cystectomy

AU - Sonpavde, Guru

AU - Khan, Myrna M.

AU - Svatek, Robert

AU - Lee, Richard

AU - Novara, Giacomo

AU - Tilki, Derya

AU - Lerner, Seth P.

AU - Amiel, Gilad E.

AU - Skinner, Eila

AU - Karakiewicz, Pierre I.

AU - Bastian, Patrick J.

AU - Kassouf, Wassim

AU - Fritsche, Hans Martin

AU - Izawa, Jonathan I.

AU - Scherr, Douglas S.

AU - Ficarra, Vincenzo

AU - Dinney, Colin P.

AU - Lotan, Yair

AU - Fradet, Yves

AU - Shariat, Shahrokh F.

PY - 2011/4

Y1 - 2011/4

N2 - Purpose: Patients with pathological T3N0 stage urothelial carcinoma of the bladder show a range of outcomes after radical cystectomy. Given that nomograms have included heterogeneous groups of patients, we focused on and stratified patients with pT3N0 urothelial carcinoma of the bladder after radical cystectomy into prognostically different risk groups to facilitate the development of adjuvant therapy trials for those at high risk. Materials and Methods: The study comprised a total of 578 patients from 9 centers worldwide with pT3N0 urothelial carcinoma of the bladder who underwent radical cystectomy without perioperative chemotherapy. We evaluated the effect of pT3 substage at radical cystectomy, age, grade, lymphovascular invasion, margin status and number of lymph nodes removed on recurrence-free survival using Cox regression analysis. A weighted prognostic model was devised. Results: Median followup was 39.4 months (IQR 64). On multivariate analysis pT3 substage at radical cystectomy (pT3b vs pT3a HR 2.056, p <0.0001), lymphovascular invasion (positive vs negative HR 2.004, p <0.0001) and margin status (positive vs negative HR 2.503, p = 0.002) were associated with recurrence-free survival (concordance index 0.66) in the context of generally adequate lymph node dissection, that is with a median of 17 removed. Three risk groups were devised based on weighted variables with a 5-year recurrence-free survival rate of 79% (95% CI 70-84), 57% (95% CI 50-64) and 37% (95% CI 26-48) in the low, intermediate and high risk groups, respectively. Conclusions: We constructed a user friendly prognostic risk model for patients with pT3N0 urothelial carcinoma of the bladder treated with radical cystectomy based on pT3 substage at radical cystectomy, lymphovascular invasion and margin status. These data warrant validation and may enable tailored monitoring and selection of appropriate patients for adjuvant therapy trials.

AB - Purpose: Patients with pathological T3N0 stage urothelial carcinoma of the bladder show a range of outcomes after radical cystectomy. Given that nomograms have included heterogeneous groups of patients, we focused on and stratified patients with pT3N0 urothelial carcinoma of the bladder after radical cystectomy into prognostically different risk groups to facilitate the development of adjuvant therapy trials for those at high risk. Materials and Methods: The study comprised a total of 578 patients from 9 centers worldwide with pT3N0 urothelial carcinoma of the bladder who underwent radical cystectomy without perioperative chemotherapy. We evaluated the effect of pT3 substage at radical cystectomy, age, grade, lymphovascular invasion, margin status and number of lymph nodes removed on recurrence-free survival using Cox regression analysis. A weighted prognostic model was devised. Results: Median followup was 39.4 months (IQR 64). On multivariate analysis pT3 substage at radical cystectomy (pT3b vs pT3a HR 2.056, p <0.0001), lymphovascular invasion (positive vs negative HR 2.004, p <0.0001) and margin status (positive vs negative HR 2.503, p = 0.002) were associated with recurrence-free survival (concordance index 0.66) in the context of generally adequate lymph node dissection, that is with a median of 17 removed. Three risk groups were devised based on weighted variables with a 5-year recurrence-free survival rate of 79% (95% CI 70-84), 57% (95% CI 50-64) and 37% (95% CI 26-48) in the low, intermediate and high risk groups, respectively. Conclusions: We constructed a user friendly prognostic risk model for patients with pT3N0 urothelial carcinoma of the bladder treated with radical cystectomy based on pT3 substage at radical cystectomy, lymphovascular invasion and margin status. These data warrant validation and may enable tailored monitoring and selection of appropriate patients for adjuvant therapy trials.

KW - carcinoma

KW - cystectomy

KW - risk

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KW - urothelium

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