title: Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  To externally validate the Christodouleas risk model incorporating pathological tumor stage, lymph node (LN) count and soft tissue surgical margin (STSM) and stratifying patients who develop locoregional recurrence (LR) after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). In addition, we aimed to generate a new model including established clinicopathological features that were absent in the Christodouleas risk model.
  
  
  METHODS
  Prospectively assessed multicenter data from 565 patients undergoing RC for UCB in 2011 qualified for final analysis. For the purpose of external validation, risk group stratification according to Christodouleas was performed. Competing-risk models were calculated to compare the cumulative incidences of LR after RC.
  
  
  RESULTS
  After a median follow-up of 25 months (interquartile range 19-29), the LR-rate was 11.5 %. The Christodouleas model showed a predictive accuracy of 83.2 % in our cohort. In multivariable competing-risk analysis, tumor stage ≥pT3 (HR 4.32, p < 0.001), positive STSM (HR 2.93, p = 0.005), lymphovascular invasion (HR 3.41, p < 0.001), the number of removed LNs <10 (HR 2.62, p < 0.001) and the administration of adjuvant chemotherapy (HR 0.40, p = 0.008) independently predicted the LR-rate. The resulting risk groups revealed significant differences in LR-rates after 24 months with 4.8 % for low-risk patients, 14.7 % for intermediate-risk patients and 38.9 % for high-risk patients (p < 0.001 for all), with a predictive accuracy of 85.6 %, respectively.
  
  
  CONCLUSIONS
  The Christodouleas risk model has been successfully externally validated in the present prospective series. However, this analysis finds that overall model performance may be improved by incorporating lymphovascular invasion. After external validation of the newly proposed risk model, it may be used to identify patients who benefit from an adjuvant therapy and suit for inclusion in clinical trials.
authors: Department of Urology, University Hospital "Carl Gustav Carus", Dresden, Germany.
authors: Vladimir
authors: V
authors: Novotny
authors: Department of Urology, University Hospital "Carl Gustav Carus", Dresden, Germany.
authors: Michael
authors: M
authors: Froehner
authors: Department of Urology, St. Elisabeth Hospital, Straubing, Germany.
authors: Matthias
authors: M
authors: May
authors: Department of Urology, University Medical Center Rostock, Rostock, Germany.
authors: Chris
authors: C
authors: Protzel
authors: Department of Urology, University Medical Center Rostock, Rostock, Germany.
authors: Katrin
authors: K
authors: Hergenröther
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors: Michael
authors: M
authors: Rink
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors: Felix K
authors: FK
authors: Chun
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors: Margit
authors: M
authors: Fisch
authors: Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany.
authors: Florian
authors: F
authors: Roghmann
authors: Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany.
authors: Rein-Jüri
authors: RJ
authors: Palisaar
authors: Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany.
authors: Joachim
authors: J
authors: Noldus
authors: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors: Michael
authors: M
authors: Gierth
authors: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors: Hans-Martin
authors: HM
authors: Fritsche
authors: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors: Maximilian
authors: M
authors: Burger
authors: Department of Urology, University Hospital Erlangen, Erlangen, Germany.
authors: Danijel
authors: D
authors: Sikic
authors: Department of Urology, University Hospital Erlangen, Erlangen, Germany.
authors: Bastian
authors: B
authors: Keck
authors: Department of Urology, University Hospital Erlangen, Erlangen, Germany.
authors: Bernd
authors: B
authors: Wullich
authors: Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors: Philipp
authors: P
authors: Nuhn
authors: Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors: Alexander
authors: A
authors: Buchner
authors: Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors: Christian G
authors: CG
authors: Stief
authors: Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany.
authors: Stefan
authors: S
authors: Vallo
authors: Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany.
authors: Georg
authors: G
authors: Bartsch
authors: Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany.
authors: Axel
authors: A
authors: Haferkamp
authors: Department of Urology, Paracelsus Medical Center Golzheim, Düsseldorf, Germany.
authors: Patrick J
authors: PJ
authors: Bastian
authors: Department of Urology, University Medical Center Rostock, Rostock, Germany.
authors: Oliver W
authors: OW
authors: Hakenberg
authors: Department of Urology, University Hospital "Carl Gustav Carus", Dresden, Germany.
authors: Stefan
authors: S
authors: Propping
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. atiqullah.aziz@gmail.com.
authors: Atiqullah
authors: A
authors: Aziz
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D015653:Cystectomy; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D049690:History, Ancient; D006801:Humans; D015994:Incidence; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery
keywords: Bladder cancer; Outcome; Radical cystectomy; Recurrence