title: Risk stratification of pT1-3N0 patients after radical cystectomy for adjuvant chemotherapy counselling.
abstract: BACKGROUND
  In pT1-T3N0 urothelial carcinoma of the bladder (UCB) patients, multi-modal therapy is inconsistently recommended. The aim of the study was to develop a prognostic tool to help decision-making regarding adjuvant therapy.
  
  
  METHODS
  We included 2145 patients with pT1-3N0 UCB after radical cystectomy (RC), naive of neoadjuvant or adjuvant therapy. The cohort was randomly split into development cohort based on the US patients (n=1067) and validation cohort based on the Europe patients (n=1078). Predictive accuracy was quantified using the concordance index.
  
  
  RESULTS
  With a median follow-up of 45 months, 5-year recurrence-free and cancer-specific survival estimates were 68% and 73%, respectively. pT-stage, ge, lymphovascular invasion, and positive margin were significantly associated with both disease recurrence and cancer-specific mortality (P-values ≤ 0.005). The accuracies of the multivariable models at 2, 5, and 7 years for predicting disease recurrence were 67.4%, 65%, and 64.4%, respectively. Accuracies at 2, 5, and 7 years for predicting cancer-specific mortality were 69.3%, 66.4%, and 65.5%, respectively. We developed competing-risk, conditional probability nomograms. External validation revealed minor overestimation.
  
  
  CONCLUSIONS
  Despite RC, a significant number of patients with pT1-3N0 UCB experience disease recurrence and ultimately die of UCB. We developed and externally validated competing-risk, conditional probability post-RC nomograms for prediction of disease recurrence and cancer-specific mortality.
authors.affiliation: Department of Urology, Weill Cornell Medical College, Starr 900, 525 East 68th Street, Box 94, New York, NY 10065, USA.
authors.forename: E
authors.initials: E
authors.lastname: Xylinas
authors.forename: E K
authors.initials: EK
authors.lastname: Cha
authors.forename: M
authors.initials: M
authors.lastname: Sun
authors.forename: M
authors.initials: M
authors.lastname: Rink
authors.forename: Q-D
authors.initials: QD
authors.lastname: Trinh
authors.forename: G
authors.initials: G
authors.lastname: Novara
authors.forename: D A
authors.initials: DA
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Pycha
authors.forename: Y
authors.initials: Y
authors.lastname: Fradet
authors.forename: S
authors.initials: S
authors.lastname: Daneshmand
authors.forename: R S
authors.initials: RS
authors.lastname: Svatek
authors.forename: H-M
authors.initials: HM
authors.lastname: Fritsche
authors.forename: W
authors.initials: W
authors.lastname: Kassouf
authors.forename: D S
authors.initials: DS
authors.lastname: Scherr
authors.forename: T
authors.initials: T
authors.lastname: Faison
authors.forename: J J
authors.initials: JJ
authors.lastname: Crivelli
authors.forename: S T
authors.initials: ST
authors.lastname: Tagawa
authors.forename: M
authors.initials: M
authors.lastname: Zerbib
authors.forename: P I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: S F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003376:Counseling; D015653:Cystectomy; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*