title: Prognostic risk stratification of patients with urothelial carcinoma of the bladder with recurrence after radical cystectomy.
abstract: OBJECTIVE
  We identify clinicopathological variables predicting overall survival in patients with recurrent bladder urothelial carcinoma after radical cystectomy.
  
  
  METHODS
  We retrospectively collected data on 114 patients treated with radical cystectomy for bladder urothelial carcinoma who subsequently had remote metastasis and/or local recurrence. The Kaplan-Meier method with the log rank test and multivariate Cox regression models were used to address overall survival after recurrence.
  
  
  RESULTS
  During followup 99 of the 114 patients died. Median survival in the 114 patients was 11.2 months. One and 3-year overall survival rates were 48.0% and 12.1%, respectively. On multivariate analysis independent predictors of poorer overall survival included less than 1 year to recurrence, symptoms at recurrence, 2 or more metastatic organs at recurrence, high serum C-reactive protein, high lactate dehydrogenase, no post-recurrence platinum based chemotherapy and no metastasectomy. Based on the 4 variables (time to recurrence, symptoms, number of metastatic organs and C-reactive protein), we constructed a risk model predicting post-recurrence overall survival that classified patients into 3 groups with significantly different overall survival (p <0.0001).
  
  
  CONCLUSIONS
  Our data confirm that recurrent urothelial carcinoma after radical cystectomy is a highly aggressive, lethal disease. Seven clinicopathological factors were identified that predicted post-recurrence overall survival. Our risk model based on the 4 variables could be useful to provide relevant prognostic information to patients and physicians, and better stratify patients in clinical trials.
authors.affiliation: Department of Urology, National Cancer Center Hospital and Division of Molecular Pathology, National Cancer Center Research Institute (EA, YK), Tokyo, Japan. tohru-tky@umin.ac.jp
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Hara
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawahara
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ogata
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakanishi
authors.forename: Motokiyo
authors.initials: M
authors.lastname: Komiyama
authors.forename: Eri
authors.initials: E
authors.lastname: Arai
authors.forename: Yae
authors.initials: Y
authors.lastname: Kanai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology* / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000601:surgery*