Postoperative Nomogram Predicting Risk of Recurrence After Radical Cystectomy for Bladder Cancer

2006 ◽  
Vol 24 (24) ◽  
pp. 3967-3972 ◽  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Predictive Accuracy ◽  
Regional Lymph Node ◽  
Recurrence Risk ◽  
Prognostic Models ◽  
Lymph Node Status ◽  
Concordance Index ◽  
Centers Of Excellence ◽  
Histologic Subtype

Purpose Radical cystectomy and pelvic lymphadenectomy (PLND) remains the standard treatment for localized and regionally advanced invasive bladder cancers. We have constructed an international bladder cancer database from centers of excellence in the management of bladder cancer consisting of patients treated with radical cystectomy and PLND. The goal of this study was the development of a prognostic outcomes nomogram to predict the 5-year disease recurrence risk after radical cystectomy. Patients and Methods Institutional radical cystectomy databases containing detailed information on bladder cancer patients were obtained from 12 centers of excellence worldwide. Data were collected on more than 9,000 postoperative patients and combined into a relational database formatted with patient characteristics, pathologic details of the pre- and postcystectomy specimens, and recurrence and survival status. Patients with available information for all selected study criteria were included in the formation of the final prognostic nomogram designed to predict 5-year progression-free probability. Results The final nomogram included information on patient age, sex, time from diagnosis to surgery, pathologic tumor stage and grade, tumor histologic subtype, and regional lymph node status. The predictive accuracy of the constructed international nomogram (concordance index, 0.75) was significantly better than standard American Joint Committee on Cancer TNM (concordance index, 0.68; P < .001) or standard pathologic subgroupings (concordance index, 0.62; P < .001). Conclusion We have developed an international bladder cancer nomogram predicting recurrence risk after radical cystectomy for bladder cancer. The nomogram outperformed prognostic models that use standard pathologic subgroupings and should improve our ability to provide accurate risk assessments to patients after the surgical management of bladder cancer.

scholarly journals Preoperative Serum Gamma-Glutamyltransferase as a Prognostic Biomarker in Patients Undergoing Radical Cystectomy for Bladder Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Shiqiang Su ◽  
Lizhe Liu ◽  
Chao Sun ◽  
Yanhua Nie ◽  
Hong Guo ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Elevated Serum ◽  
Disease Free Survival ◽  
Prognostic Models ◽  
Lymph Node Status ◽  
Cancer Specific Survival ◽  
Gamma Glutamyltransferase ◽  
Preoperative Serum

BackgroundSerum gamma-glutamyltransferase (GGT) has been reported to be correlated with survival in a variety of malignancies. However, its effect on patients with bladder cancer (BC) treated by radical cystectomy has never been evaluated.Patients and MethodsWe retrospectively evaluated 263 patients who underwent radical surgery in our center. Baseline features, hematologic variables, and follow-up data were obtained. The endpoints included overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). The relationship between GGT and survival were evaluated.ResultsThe median follow-up period for all patients was 34.7 (22.9-45.9) months. At the last follow-up, 67 patients died, 51 patients died of cancer, 92 patients experienced disease recurrence. Patients with an elevated serum GGT had a higher rate of pT3-T4 tumors. Patients with a higher preoperative serum GGT had a lower rate of OS, CSS and DFS (P &lt; 0.001 for all). Multivariate analysis identified that preoperative serum GGT was independent predictor of OS (HR: 3.027, 95% CI: 1.716-5.338; P &lt; 0.001), CSS (HR: 2.115, 95% CI: 1.093-4.090; P = 0.026), DFS (HR: 2.584, 95% CI: 1.569-4.255; P &lt; 0.001). Age, diabetes history, pathologic T stage, and lymph node status also were independent predictors of prognosis for BC patients.ConclusionsOur results indicated that preoperative serum GGT was an independent prognosis predictor for survival of BC patients after radical cystectomy, and can be included in the prognostic models.

scholarly journals Regional lymph node status in patients with bladder cancer found to be pathological stage T0 at radical cystectomy following systemic chemotherapy

2011 ◽  
Vol 108 (8b) ◽  
pp. E272-E277 ◽  
Author(s):  
Matthew G. Kaag ◽  
Matthew I. Milowsky ◽  
Guido Dalbagni ◽  
R. Houston Thompson ◽  
Darren Katz ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Systemic Chemotherapy ◽  
Regional Lymph Node ◽  
Lymph Node Status ◽  
Pathological Stage ◽  
Node Status

scholarly journals Predictors of Outcome of Non–Muscle-Invasive and Muscle-Invasive Bladder Cancer

2011 ◽  
Vol 11 ◽  
pp. 369-381 ◽  
Author(s):  
Ramy F. Youssef ◽  
Yair Lotan
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Predictive Accuracy ◽  
Staging System ◽  
Tumor Grade ◽  
Invasive Disease ◽  
Tnm Staging ◽  
High Rate ◽  
Recurrence Rates ◽  
Muscle Invasive

Bladder cancer is a major cause of morbidity and mortality. At initial diagnosis, 75% of patients present with non–muscle-invasive disease and 25% of patients have muscle-invasive or metastatic disease.Patients with noninvasive disease suffer from a high rate of recurrence and 10–30% will have disease progression. Patients with muscle-invasive disease are primarily treated with radical cystectomy, but frequently succumb to their disease despite improvements in surgical technique. In non–muscle-invasive disease, multiplicity, tumor size, and prior recurrence rates are the most important predictors for recurrence, while tumor grade, stage, and carcinomain situare the most important predictors for progression. The most common tool that clinicians use to predict outcomes after radical cystectomy is still the tumor-node-metastasis (TNM) staging system, with lymph node involvement representing the most important prognostic factor. However, the predictive accuracy of staging and grading systems are limited, and nomograms incorporating clinical and pathologic factors can improve prediction of bladder cancer outcomes. One limitation of current staging is the fact that tumors of a similar stage and grade can have significantly different biology. The integration of molecular markers, especially in a panel approach, has the potential to further improve the accuracy of predictive models and may also identify targets for therapeutic intervention or patients who will respond to systemic therapies.

Effect of delayed radical cystectomy for invasive bladder tumors on lymph node positivity, cancer-specific survival and total survival

2018 ◽  
Vol 104 (6) ◽  
pp. 434-437
Author(s):  
Hakan Türk ◽  
Sıtkı Ün ◽  
Ahmet Cinkaya ◽  
Hilmi Kodaz ◽  
Murtaza Parvizi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Transitional Cell ◽  
Invasive Bladder Cancer ◽  
Lymph Node Status ◽  
Muscle Invasive Bladder Cancer ◽  
Cancer Specific Survival ◽  
Muscle Invasive

Introduction: Radical cystectomy (RC) is the main treatment option for patients with muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC), which carry the highest risk of progression. In this study, we investigated the effect of time from transurethral resection of the bladder (TUR-B) to cystectomy on lymph node positivity, cancer-specific survival and overall survival in patients with MIBC. Methods: The records were reviewed of 530 consecutive patients who had RC and pelvic lymphadenectomy procedures with curative intent performed by selected surgeons between May 2005 and April 2016. Our analysis included only patients with transitional cell carcinoma of the bladder; we excluded 23 patients with other types of tumor histology. Results: Patients who underwent delayed RC were compared with patients who were treated with early RC; both groups were similar in terms of age, gender, T stage, tumor grade, tumor differentiation, lymph node status and metastasis status. However, when both groups were compared for disease-free survival and overall survival, patients of the early-RC group had a greater advantage. Conclusions: The optimal time between the last TUR-B and RC is still controversial. A reasonable time for preoperative preparation can be allowed, but long delays, especially those exceeding 3 months, can lead to unfavorable outcomes in cancer control.

p53, p21, pRB, and p16 Expression Predict Clinical Outcome in Cystectomy With Bladder Cancer

2004 ◽  
Vol 22 (6) ◽  
pp. 1014-1024 ◽  
Author(s):  
Shahrokh F. Shariat ◽  
Hideo Tokunaga ◽  
JainHua Zhou ◽  
JaHong Kim ◽  
Gustavo E. Ayala ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Cancer Progression ◽  
Lymph Node Metastases ◽  
Lymph Node Status ◽  
Altered Expression ◽  
Pathologic Features ◽  
Node Metastases ◽  
P16 Expression

Purpose To determine whether p53, p21, pRB, and/or p16 expression is associated with bladder cancer stage, progression, and prognosis. Patients and Methods Immunohistochemical staining for p53, p21, pRB, and p16 was carried out on serial sections from archival specimens of 80 patients who underwent bilateral pelvic lymphadenectomy and radical cystectomy for bladder cancer (median follow-up, 101 months). Results p53, p21, and pRB or p16 expression was altered in 45 (56%), 39 (49%), and 43 (54%) tumors, respectively. Sixty-six patients (83%) had at least one marker altered, and 21 patients (26%) had all three altered. Abnormal expressions of p53, p21, and pRB/p16 expression were associated with muscle-invasive disease (P = .007, P = .003, and P = .003, respectively). The alteration of each marker was independently associated with disease progression (P ≤ .038) and disease-specific survival (P ≤ .039). In multivariable models that included standard pathologic features and p53 with p21 or p53 with pRB/p16, only p53 and lymph node metastases were associated with bladder cancer progression (P ≤ .026) and death (P ≤ .028). In models that included p21 and pRB/p16, only p21 and lymph node metastases were associated with bladder cancer progression (P ≤ .022) and death (P ≤ .028). In a model that included the combined variables p53/p21 and pRB/p16, only p53/p21 and lymph node status were associated with bladder cancer progression (P ≤ .047) and death (P ≤ .036). The incremental number of altered markers was independently associated with an increased risk of bladder cancer progression (P = .005) and mortality (P = .007). Conclusion Although altered expression of each of the four cell cycle regulators is associated with bladder cancer outcome in patients undergoing radical cystectomy, p53 is the strongest predictor, followed by p21, suggesting a more pivotal role of the p53/p21 pathway in bladder cancer progression.

scholarly journals Preoperative lymphocyte-to-monocyte ratio improves the prediction of survival outcomes after radical cystectomy for bladder cancer

2020 ◽  
Author(s):  
Hai Bi ◽  
Ye Yan ◽  
Zijian Qin ◽  
Guoliang Wang ◽  
Lulin Ma ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Clinical Decision Making ◽  
Cox Regression ◽  
Predictive Accuracy ◽  
Prognostic Significance ◽  
Survival Outcomes ◽  
Operating Characteristics ◽  
Net Benefit ◽  
Term Survival

Abstract Purpose To determine the prognostic significance of preoperative lymphocyte-to-monocyte (LMR) in bladder cancer (BCa) patients undergoing radical cystectomy (RC), and to validate the prognostic benefit provided by LMR compared to the models relying on the clinicopathological factors alone. Materials and Methods Retrospective analysis of the 342 BCa patients undergoing RC at our institution from 2004 to 2017 was performed to evaluate the prognostic significance of the LMR. Overall survival (OS) and cancer-specific survival (CSS) was assessed by the Kaplan-Meier method. Cox regression models identified risk factors for survival outcomes. Two nomograms were developed based on the basal models to predict the OS and CSS at 1, 3 and 5 years after RC. The accuracy of the nomograms was assessed with receiver operating characteristics (ROC) curves and concordance-index. Decision curve analyses (DCA) were performed to identify the net benefit by the nomograms. Results Excellent long-term survival outcomes of patients were associated with higher LMR level patients. The median survival time for higher LMR level patients was 98.8 months in OS and over 120 months in CSS. In Cox regression multivariate analysis, preoperative LMR, as a continuous variable, is an independent survival outcome predictor ( p <0.001). The addition of LMR to standard model significantly improved its discrimination for prediction of OS by 5.8% and CSS by 5.4% (both p <0.001). Moreover, as shown in DCA, the use of the nomogram including LMR would incur a net benefit over the base models for predicting OS and CSS at 1, 3 and 5 years. Conclusions Elevated preoperative LMR among BCa patients undergoing RC is independently associated with significantly better OS and CSS. Moreover, the increase in predictive accuracy after the inclusion of LMR in multiparametric prediction tools is significant. Therefore, LMR may be useful in preoperative patient risk stratification to help patient counseling and clinical decision making.

scholarly journals Development and Validation of a Prognostic Nomogram in Patients with Bladder Cancer after Radical Cystectomy: A Study Based on the Chinese Population

2021 ◽  
Author(s):  
Xun Lu ◽  
Yiduo Wang ◽  
Qi Chen ◽  
Di Xia ◽  
Hanyu Zhang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Validation Cohort ◽  
Disease Free Survival ◽  
Calibration Plot ◽  
Concordance Index ◽  
Free Survival ◽  
Training Cohort ◽  
Disease Free

Abstract PurposeTo develop and validate a prognostic nomogram in patients with bladder cancer who underwent radical cystectomy based on the Chinese population.MethodsThe nomogram was built on a retrospective study included 191 patients with bladder cancer who underwent radical cystectomy between January 2010 to December 2019 at the authors’ hospital. The primary cohort was divided into the training cohort and the validation cohort randomly. The endpoints in the study were disease-free survival and overall survival. The ability of distinguishing and predicting of the prognostic nomogram were determined by calibration plot and concordance index in the training cohort. Moreover, the results were also verified in the validation cohort internally.ResultsMultivariate analysis of the training cohort showed that hydronephrosis, Stage_T, Stage_N, PNI and EGFR were significantly associated with overall survival. Meanwhile, Stage_T, Stage_N, PNI and EGFR were independent risk factors for disease-free survival. The calibration plot agreed well between prediction and actual observation in survival possibility. The concordance index of the nomogram in the training cohort of overall survival and disease-free survival were 0.834 (95%CI: 0.785-0.833) and 0.823 (95%CI: 0.772-0.873), respectively. In the validation cohort, the nomogram also showed high predictive accuracy.ConclusionThe proposed nomogram showed high accuracy in predicting survival for bladder cancer patients after radical cystectomy.

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