Prognostic risk stratification of pathological stage T2N0 bladder cancer after radical cystectomy

Authors


  • Presented in part as a podium presentation at the American Urological Association (AUA) Annual Conference May 2010, San Francisco, CA, USA.

Guru Sonpavde, 501 Medical Center Blvd, Webster, TX 77598, USA. e-mail: guru.sonpavde@usoncology.com

Abstract

Study Type – Therapy (individual cohort)

Level of Evidence 2b

What’s known on the subject? and What does the study add?

Patients with urothelial carcinoma of the bladder (UCB) and pathological (p) stage T2N0 disease exhibit a range of clinical outcomes with an overall estimated 10–25% experiencing recurrence and death after radical cystectomy (RC). Nomograms to prognosticate UCB post-RC have been developed in heterogeneous datasets of patients across different stages and do not address factors unique to pT2N0 disease.

A user-friendly prognostic risk model was devised for patients with pT2N0 UCB undergoing RC based on residual pathological stage at RC (pT2a, pT2b, <pT2), grade (high, low) and lymphovascular invasion (present or absent). The three risk groups exhibited five-year recurrence-free survivals of 95%, 86% and 62%, respectively. These data warrant validation and may help design adjuvant therapy trials as well as tailor the intensity of post-operative monitoring.

OBJECTIVE

• To stratify risk of pathological (p) T2N0 urothelial carcinoma of the bladder after radical cystectomy (RC) based on pathological factors to facilitate the development of adjuvant therapy trials for high-risk patients.

PATIENTS AND METHODS

• The study comprised 707 patients from a database of patients with pT2N0 urothelial carcinoma of the bladder who had undergone RC and not received perioperative chemotherapy.

• The effect of residual pT-stage at RC, age, grade, lymphovascular invasion and number of lymph nodes removed on recurrence-free survival was evaluated using Cox regression analyses. A weighted prognostic model was devised with significant variables.

RESULTS

• The median follow up was 60.9 months. In multivariable analyses, residual disease at RC (pT2a: hazard ratio (HR) 1.740, P = 0.03; for pT2b: HR 3.075, P < 0.001; both compared with <pT2), high-grade (HR 2.127, P = 0.09) and lymphovascular invasion (HR 2.234, P < 0.001) were associated with recurrence-free survival (c = 0.70).

• Three risk groups were devised based on weighted variables with 5-year recurrence-free survival of 95% (95% CI 87–98), 86% (95% CI 81–90) and 62% (95% CI 54–69) in the good-risk, intermediate-risk and poor-risk groups, respectively (c = 0.68). The primary limitation is the retrospective and multicenter feature.

CONCLUSIONS

• A prognostic risk model for patients with pT2N0 bladder cancer undergoing RC with generally adequate lymph node dissection was constructed based on residual pathological stage at RC, grade and lymphovascular invasion.

• These data warrant validation and may enable the selection of patients with high-risk pT2N0 urothelial carcinoma of the bladder for adjuvant therapy trials.

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