Radical cystectomy with neoadjuvant chemotherapy has become the accepted optimal treatment for patients presenting with muscle-invasive bladder cancer . Yet, despite improved surgical technique and peri-operative care, cystectomy remains a morbid procedure with the potential for significant early and late surgical complications as well as mortality . Furthermore, as this paper and others have demonstrated , the clinical staging of bladder cancer is inexact and a significant discordance exists between clinical and pathological staging. Being able to accurately identify preoperatively the optimal treatment algorithm on an individualized basis is the ideal, minimizing toxicities/side effects of unnecessary treatments while maximizing cancer cure.
In ‘Principal component analysis based pre-cystectomy model to predict pathological stage in patients with clinical organ-confined bladder cancer’, the authors generate a model using their robust institutional database to predict the pathological stage in patients with bladder cancer using preoperative clinical variables. Their straightforward user-friendly model increases the ability to more accurately predict a patient's post-surgical pathological stage. Models such as the one presented are imperative to better inform patient risk stratification as well as allow for optimization of patient care. The authors correctly concede that their model is only a start with a need for more precise variables, which will strengthen the predictive ability of this or any other model.
Models such as the one presented in this paper are an important step in standardizing and objectifying the treatment of patients with muscle-invasive bladder cancer. The ability to predict not only postoperative pathological outcomes as well as complication events in patients with bladder cancer cannot be overemphasized. As is becoming more evident, quality of life is just as important to patients and their families as quantity of life and, as such, a thoughtful nuanced care of patients with invasive bladder cancer is imperative.