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01-11-2015 | Original Article

Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder

Authors: Vladimir Novotny, Michael Froehner, Matthias May, Chris Protzel, Katrin Hergenröther, Michael Rink, Felix K. Chun, Margit Fisch, Florian Roghmann, Rein-Jüri Palisaar, Joachim Noldus, Michael Gierth, Hans-Martin Fritsche, Maximilian Burger, Danijel Sikic, Bastian Keck, Bernd Wullich, Philipp Nuhn, Alexander Buchner, Christian G. Stief, Stefan Vallo, Georg Bartsch, Axel Haferkamp, Patrick J. Bastian, Oliver W. Hakenberg, Stefan Propping, Atiqullah Aziz

Published in: World Journal of Urology | Issue 11/2015

Abstract

Purpose

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.

Methods

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.

Results

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 ≥pT3 (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.

Conclusions

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.

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Title: Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder
Authors: Vladimir Novotny
Michael Froehner
Matthias May
Chris Protzel
Katrin Hergenröther
Michael Rink
Felix K. Chun
Margit Fisch
Florian Roghmann
Rein-Jüri Palisaar
Joachim Noldus
Michael Gierth
Hans-Martin Fritsche
Maximilian Burger
Danijel Sikic
Bastian Keck
Bernd Wullich
Philipp Nuhn
Alexander Buchner
Christian G. Stief
Stefan Vallo
Georg Bartsch
Axel Haferkamp
Patrick J. Bastian
Oliver W. Hakenberg
Stefan Propping
Atiqullah Aziz
Publication date: 01-11-2015
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 11/2015
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1502-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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