title: EORTC progression score identifies patients at high risk of cancer-specific mortality after radical cystectomy for secondary muscle-invasive bladder cancer.
abstract: BACKGROUND
  The aim of this study was to develop a risk stratification of patients with muscle-invasive bladder cancer (MIBC) after radical cystectomy (RC). For this purpose, we compared the cancer-specific mortality (CSM) of patients with primary MIBC and patients with secondary MIBC in different risk groups according to the European Organisation for Research and Treatment of Cancer (EORTC) progression score.
  
  
  METHODS
  The records of 521 consecutive patients treated with RC for clinical MIBC according to transurethral resection of bladder cancer (TURBT) diagnosis were reviewed. Of the 521 patients, 399 (76.6%) had primary MIBC (study group 1 [SG1]) and 122 (23.4%) had secondary MIBC (study group 2 [SG2]). Patients in SG2 were stratified into risk groups according to the results of the first and last TURBT in non-MIBC using the EORTC progression score.
  
  
  RESULTS
  CSM for patients with primary and secondary MIBC did not differ significantly. Patients in SG2 with the highest risk for tumor stage progression at time of the first and last TURBT in non-MIBC showed a significantly higher CSM after RC compared with patients with low-to-intermediate risk and compared with patients in SG1. In multivariable analyses, stage pT 3/4 (hazard ratio [HR], 2.12; P < .001), lymphovascular invasion (LVI) (HR, 3.47; P < .001), female sex (HR, 1.35; P = .048), and time from diagnosis of MIBC to RC > 90 days (HR, 2.07; P < .001) were significantly associated with higher CSM.
  
  
  CONCLUSIONS
  Risk stratification by the EORTC progression score can help to identify those patients with the highest risk of CSM after progression to MIBC and thus enable us to offer these patients a multimodal treatment. Our results need to be verified in large prospective studies.
authors: Department of Urology, St. Elisabeth Klinikum Straubing, Straubing, Germany; Department of Urology, Vivantes Kliniken Am Urban und Im Friedrichshain Berlin, Berlin, Germany; Department of Urology, Vivantes Kliniken AVK Berlin, Berlin, Germany. Electronic address: matthias.may@klinikum-straubing.de.
authors: Matthias
authors: M
authors: May
authors: Department of Urology, University of Regensburg, Caritas-St. Josef Medical Center, Regensburg, Germany.
authors: Maximilian
authors: M
authors: Burger
authors: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors: Sabine
authors: S
authors: Brookman-May
authors: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors: Christian G
authors: CG
authors: Stief
authors: Department of Urology, University of Regensburg, Caritas-St. Josef Medical Center, Regensburg, Germany.
authors: Hans-Martin
authors: HM
authors: Fritsche
authors: Department of Urology, Vivantes Kliniken Am Urban und Im Friedrichshain Berlin, Berlin, Germany.
authors: Jan
authors: J
authors: Roigas
authors: Department of Urology, Vivantes Kliniken AVK Berlin, Berlin, Germany.
authors: Mario
authors: M
authors: Zacharias
authors: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors: Markus
authors: M
authors: Bader
authors: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors: Philipp
authors: P
authors: Mandel
authors: Department of Urology, St. Elisabeth Klinikum Straubing, Straubing, Germany.
authors: Christian
authors: C
authors: Gilfrich
authors: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors: Michael
authors: M
authors: Seitz
authors: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors: Derya
authors: D
authors: Tilki
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019042:Muscle Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery
keywords: EORTC risk tables; Muscle invasion; Prognosis; Risk stratification; Urothelial carcinoma of the bladder