title: Prognostic risk stratification of pathological stage T2N0 bladder cancer after radical cystectomy.
abstract: OBJECTIVE
  • To stratify risk of pathological (p) T2N0 urothelial carcinoma of the bladder after radical cystectomy (RC) based on pathological factors to facilitate the development of adjuvant therapy trials for high-risk patients.
  
  
  METHODS
  • The study comprised 707 patients from a database of patients with pT2N0 urothelial carcinoma of the bladder who had undergone RC and not received perioperative chemotherapy. • The effect of residual pT-stage at RC, age, grade, lymphovascular invasion and number of lymph nodes removed on recurrence-free survival was evaluated using Cox regression analyses. A weighted prognostic model was devised with significant variables.
  
  
  RESULTS
  • The median follow up was 60.9 months. In multivariable analyses, residual disease at RC (pT2a: hazard ratio (HR) 1.740, P = 0.03; for pT2b: HR 3.075, P < 0.001; both compared with <pT2), high-grade (HR 2.127, P = 0.09) and lymphovascular invasion (HR 2.234, P < 0.001) were associated with recurrence-free survival (c = 0.70). • Three risk groups were devised based on weighted variables with 5-year recurrence-free survival of 95% (95% CI 87-98), 86% (95% CI 81-90) and 62% (95% CI 54-69) in the good-risk, intermediate-risk and poor-risk groups, respectively (c = 0.68). The primary limitation is the retrospective and multicenter feature.
  
  
  CONCLUSIONS
  • A prognostic risk model for patients with pT2N0 bladder cancer undergoing RC with generally adequate lymph node dissection was constructed based on residual pathological stage at RC, grade and lymphovascular invasion. • These data warrant validation and may enable the selection of patients with high-risk pT2N0 urothelial carcinoma of the bladder for adjuvant therapy trials.
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. guru.sonpavde@usoncology.com
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: Myrna M
authors.initials: MM
authors.lastname: Khan
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
authors.forename: Gilad E
authors.initials: GE
authors.lastname: Amiel
authors.forename: Eila
authors.initials: E
authors.lastname: Skinner
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Izawa
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology*; D049451:Nomograms; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*