Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710
Version of Record online: 3 JAN 2014
© 2013 American Cancer Society
Volume 120, Issue 8, pages 1272–1280, 15 April 2014
How to Cite
Christodouleas, J. P., Baumann, B. C., He, J., Hwang, W.-T., Tucker, K. N., Bekelman, J. E., Tangen, C. M., Lerner, S. P., Guzzo, T. J. and Malkowicz, S. B. (2014), Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710. Cancer, 120: 1272–1280. doi: 10.1002/cncr.28544
- Issue online: 8 APR 2014
- Version of Record online: 3 JAN 2014
- Manuscript Accepted: 22 NOV 2013
- Manuscript Revised: 21 NOV 2013
- Manuscript Received: 17 SEP 2013
Errata: Erratum: Christodouleas JP, Baumann BC, He J, Hwang W-T, Tucker KN, Bekelman JE, Tangen CM, Lerner SP, Guzzo TJ and Malkowicz SB. Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710 Cancer. 2014;120:1272-80
Vol. 121, Issue 1, 162, Version of Record online: 9 SEP 2014
- bladder cancer;
- urothelial cancer;
- local failure;
- adjuvant radiation
Clinical trials of radiation after radical cystectomy (RC) and chemotherapy for bladder cancer are in development, but inclusion and stratification factors have not been clearly established. In this study, the authors evaluated and refined a published risk stratification for locoregional failure (LF) by applying it to a multicenter patient cohort.
The original stratification, which was developed using a single-institution series, produced 3 subgroups with significantly different LF risk based on pathologic tumor (pT) classification and the number of lymph nodes identified. This model was then applied to patients in Southwest Oncology Group (SWOG) 8710, a randomized trial of RC with or without chemotherapy. LF was defined as any pelvic failure before or within 3 months of distant failure.
Patients in the development cohort and the SWOG cohort had significantly different baseline characteristics. The original risk model was not fully validated in the SWOG cohort, because lymph node yield was not as strongly associated with LF as in the development cohort. Regression analysis indicated that margin status could improve the model. A revised stratification using pT classification, margin status, and the number of lymph nodes identified produced 3 subgroups with significantly different LF risk in both cohorts: low risk (≤pT2), intermediate risk (≥pT3 with negative margins AND ≥10 lymph nodes identified), and high risk (≥pT3 with positive margins OR <10 lymph nodes identified) with 5-year LF rates of 8%, 20%, and 41%, respectively, in the SWOG cohort and 8%, 19%, and 41%, respectively, in the development cohort.
A model incorporating pT classification, margin status, and the number of lymph nodes identified stratified LF risk in 2 different RC populations and may inform the design of future trials. Cancer 2014;120:1272–1280. © 2014 American Cancer Society.