title: Prognostic-factors-based risk-stratification model for invasive urothelial carcinoma of the urinary bladder in Taiwan.
abstract: Objectives. To develop a prognostic-factors-based predictive model for invasive urothelial carcinoma of the urinary bladder derived from statistical comparison of clinical characteristics.Methods. The medical records for patients with invasive urinary bladder urothelial carcinoma were reviewed. Clinical data for age, sex, serum lactate dehydrogenase, creatinine, albumin, alkaline phosphatase, alanine aminotransferase, total bilirubin and hemoglobin levels, white blood cell and platelet counts, positive urine cytology, Eastern Cooperative Oncology Group performance status score, tumor size, histologic grading, T stage, presence of lymph node metastases, squamous differentiation, hydronephrosis, prostatic involvement, Charlson comorbidity index, surgical procedures, and adjuvant chemotherapy status were recorded. Univariate and multivariate analyses were performed to test independent factors for prediction of survival and disease recurrence.Results. After univariate and multivariate analyses, six independent prognostic factors were found: T stage, grading, prostatic involvement, Eastern Cooperative Oncology Group performance status score, and pretreatment serum creatinine and albumin levels. A scoring system was developed on the basis the relative risk associated with the proposed prognostic factors and patients were stratified into three groups according to their scores, with statistically significant prognostic differences revealed for each of the between-group comparisons. Independent factors affecting recurrence-free survival and best predicted disease recurrence were pretreatment serum creatinine, T stage, and surgical procedure.Conclusions. This prognostic-factors-based risk-stratification model for invasive urothelial carcinoma of the urinary bladder may help clinicians predict outcome and select the most appropriate therapeutic modalities. The incidence of recurrent disease is significantly higher for patients with poor renal function before treatment or advanced T stage and those undergoing transurethral tumor resection instead of radical cystectomy.
authors.affiliation: Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, People's Republic of China, Taipei, Taiwan.
authors.forename: Muh Hwa
authors.initials: MH
authors.lastname: Yang
authors.forename: Chueh Chuan
authors.initials: CC
authors.lastname: Yen
authors.forename: Po Min
authors.initials: PM
authors.lastname: Chen
authors.forename: Wei Shu
authors.initials: WS
authors.lastname: Wang
authors.forename: Yen Hwa
authors.initials: YH
authors.lastname: Chang
authors.forename: William Ji-Shien
authors.initials: WJ
authors.lastname: Huang
authors.forename: Frank S
authors.initials: FS
authors.lastname: Fan
authors.forename: Tzeon Jye
authors.initials: TJ
authors.lastname: Chiou
authors.forename: Jin Hwang
authors.initials: JH
authors.lastname: Liu
authors.forename: Kuang Kuo
authors.initials: KK
authors.lastname: Chen
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002295:Carcinoma, Transitional Cell / Q000097:blood / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D009363:Neoplasm Proteins / Q000097:blood; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology
chemical_list: D009363:Neoplasm Proteins