A nomogram predicting the cancer-specific mortality in patients eligible for radical cystectomy evaluating clinical data and neoadjuvant cisplatinum-based chemotherapy

Trapani, Ettore Di; Sánchez-Salas, Rafael; Gandaglia, Giorgio; Rocchini, Lorenzo; Moschini, Marco; Lizée, D.; Carneiro, Ariê; Sivaraman, Arjun; Barret, Éric; Rozet, François; Galiano, Marc; Bennamoun, Mostefa; Colombo, Renzo; Suardi, Nazareno; Briganti, Alberto; Montorsi, Francesco; Cathelineau, Xavier

doi:10.1007/s00345-015-1640-2

Cited by 16 publications

(31 citation statements)

References 20 publications

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“…The pathologic tumor stage and grade and node status were found to have a direct correlation with the risk of recurrence. This association was confirmed in other nomograms developed in wide international series [ 52 , 53 ].…”

Section: Evidence Synthesissupporting

confidence: 78%

Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature

et al. 2017

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PurposeTo review the currently available literature reporting the patterns of recurrence and their predictive factors after open radical cystectomy (RC) for bladder cancer.MethodsA review of the literature was performed using the MEDLINE, Scopus and Web of Sciences databases from January 1997 to May 2017. The PRISMA guidelines were followed for the conduct of the study.ResultsLocal recurrence rate ranges between 30 and 54%. Distant recurrence is not often standardized and is reported in up to 50% of cases. The overall 5-year recurrence-free survival rates from 58 to 81%. The mean follow-up of studies included in the analysis ranged from 18 to 350 months. Details on the most important demographic and epidemiological, clinical, histologic and pathologic predictors of recurrence after radical cystectomy are provided through an evidence-based approach. The impact of the extension of lymph node dissection on recurrence after RC is investigated.ConclusionsA correct prognostic assessment is essential for patients undergoing radical cystectomy for bladder cancer, thereby potentially improving their oncologic outcomes.Electronic supplementary materialThe online version of this article (10.1007/s00345-017-2115-4) contains supplementary material, which is available to authorized users.

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Section: Evidence Synthesissupporting

confidence: 78%

Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature

et al. 2017

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“…Although evidence suggests a survival benefit of 5% at 5 years for NAC, usage in clinical practice is rather low with approximately 20% [11, 12], whereas AC seems more popular despite limited evidence [11, 13]. With the present work, we show a high acceptance of NAC among German urologists.…”

Section: Discussionsupporting

confidence: 52%

Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice

et al. 2018

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Background: Guidelines support the use of neoadjuvant (NAC) and adjuvant (AC) chemotherapy in muscle-invasive bladder cancer. However, data from North America reported the underutilization of NAC in favor of AC despite the lower level of scientific evidence supporting AC. We aimed to assess current practice patterns of NAC and AC in Germany. Methods: A 15-question online survey was developed and sent via email newsletters to members of the German Association of Urology and of the German Society of Residents in Urology in October 2016 to analyze current practice patterns. Results: The survey yielded 141 individual responses from 61 different German urology departments. Eighty-nine (69.0%) and 119 (93.0%) participants were stated to regularly use NAC and AC respectively. The number of participants who were stated to use NAC and AC regularly was not associated with the type of institution (academic vs. nonacademic), number of hospital beds, and number of cystectomies performed annually. Gemcitabine/cisplatin combination chemotherapy was named as the primarily used NAC regimen by 80 (95%) respondents. The median number of administered cycles was 3 for NAC and 4 for AC. In the case of cisplatin ineligibility, combination chemotherapy with gemcitabine/carboplatin was the most common regimen. Respondents stated that chemotherapy was generally administered by urologists (81% for NAC and 85% for AC). Conclusions: Our survey of current practice shows a high acceptance rate of NAC in Germany, which was independent of the type of institution. Although the scientific level of evidence for AC is lower, it still seems to be more widely accepted than NAC. NAC and AC were generally administered by urologists.

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“…This association was confirmed in other nomograms developed in international series. 16,17 However, close evaluation from these international appraisals aimed at collecting characteristics and outcomes of more advanced patients (eg, patients with at least muscle-invasive tumor receiving neoadjuvant or adjuvant chemotherapy) reveal that tumor grade becomes redundant and other patient-related factors, like age, Charlson Comorbidity Index, and the administration of perioperative chemotherapy might become significant in multivariable analyses. The characteristics of development and validation cohorts in our study have similar distribution of identified significant prognostic factors for locoregional RFS, with the only exception being represented by the proportion of patients who received perioperative chemotherapy, because that was much lower in the San Raffaele cohort.…”

Section: Discussionmentioning

confidence: 99%

Development of a Prediction Tool for Exclusive Locoregional Recurrence After Radical Cystectomy in Patients With Muscle-Invasive Bladder Cancer

Necchi

Pond

Moschini

et al. 2019

Clinical Genitourinary Cancer

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We analyzed prognostic factors and developed a prediction tool for exclusive locoregional (pelvic) recurrences after radical cystectomy for bladder cancer. We identified a subgroup of patients with the highest risk who might be best suited for clinical studies. Background: Limited information is available about the pattern of relapse after perioperative chemotherapy with radical cystectomy (RC) vs. RC alone in muscle-invasive bladder cancer. Patients and Methods: Data from 1082 patients of the Retrospective International Study of Invasive/Advanced Cancer of the Urothelium database, treated from February 1990 to December 2013 at 27 centers in the United States, Europe, Israel, and Canada, were collected. Locoregional relapse was defined as any pelvic lymph node or soft tissue-only recurrences. Cumulative incidence methods were used to estimate time to locoregional relapse (TTR L). Cox regression analyses were performed and a nomogram for 12-month locoregional relapse-free survival (RFS) was developed. The nomogram was applied to an external data set (n = 1021). Results: A total of 517 patients (47.8%) developed a relapse: 177 (16.4%) exclusive locoregional relapse. In multivariable analyses, perioperative chemotherapy was associated with longer TTR L (P < .001). Other factors were nonurothelial histology (P = .013), pT-stage (P < .001), and surgical margins (P < .001). The concordance index of the model was 0.681 (95% bootstrapped confidence interval, 0.666-0.716). Risk group categories were obtained according to nomogram tertiles. Despite, overall, observed locoregional RFS in the validation cohort exceeding predicted results, for high-risk patients (80 points or less, lowest nomogram tertile) observed 12-month RFS was similar between development and validation cohorts (60.1% and 66.6%). The study is limited by its retrospective nature. Conclusion: In the largest study, to our knowledge, that analyzed locoregional recurrences after RC, we propose a risk prediction tool for exclusive locoregional failures that might be suitable for clinical studies. Patients best suited for adjuvant radiotherapy might be those within the lowest nomogram tertile. Prospective trials are needed to validate findings.

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A nomogram predicting the cancer-specific mortality in patients eligible for radical cystectomy evaluating clinical data and neoadjuvant cisplatinum-based chemotherapy

Abstract: We developed the first nomogram predicting the 36-month CSM rate in patients with high-risk BCa according to the clinical data. Moreover, we demonstrate that preoperative cisplatinum-based chemotherapy is associated with better CSS.

Cited by 16 publications

References 20 publications

Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature

Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature

Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice

Development of a Prediction Tool for Exclusive Locoregional Recurrence After Radical Cystectomy in Patients With Muscle-Invasive Bladder Cancer

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