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

Abstract

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.

Blockade of DC-SIGN+ Tumor-Associated Macrophages Reactivates Antitumor Immunity and Improves Immunotherapy in Muscle-Invasive Bladder Cancer

“…The prognosis of MIBC remains largely unchanged in the past several decades, partly because of insufficient therapeutic options (30). Recent studies indicated that MIBC can be classified into multiple molecular subtypes, suggesting patients with MIBC may require personalized therapeutic strategies based on their molecular signatures (31).…”

A novel 17 apoptosis-related genes signature could predict overall survival for bladder cancer and its associations with immune infiltration

“…Similar to that of Europe, its global SIR is 4.3 for female and 20.2 for male [ 29 , 30 ]. Of all European countries, the highest SIR is in Greece with 4.5 in women and 40.4 in men, while the lowest is in Austria with 3.0 in women and 9.9 in men [ 31 ].…”

Patterns of Locoregional Recurrence after Radical Cystectomy for Stage T3-4 Bladder Cancer: A Radiation Oncologist's Point of View

“…Although their results corroborate the use of adjuvant RT for improving locoregional control and disease-free survival or OS, the findings are not definitive due to their small sample sizes, retrospective study design, and heterogeneities. 9 19 20 Two historical prospective randomized trials from Egypt have demonstrated that postoperative RT improved locoregional control and disease-free survival; the 5-year locoregional control rate was 93% in the postoperative RT group and 50% in the observational group ( p < 0.05). 9 19 However, this study was limited by the fact that only 20% of the patients had urothelial cell carcinoma, and that an old RT technique (2D RT) was used.…”