MP49-15 DEVELOPMENT OF A NOMOGRAM TO PREDICT ACHIEVEMENT OF TRIFECTA OUTCOMES IN PATIENTS RECEVING ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL ORTHOTOPIC NEOBLADDER

You have accessJournal of UrologyBladder Cancer: Invasive I (MP49)1 Apr 2020MP49-15 DEVELOPMENT OF A NOMOGRAM TO PREDICT ACHIEVEMENT OF TRIFECTA OUTCOMES IN PATIENTS RECEVING ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL ORTHOTOPIC NEOBLADDER Umberto Anceschi*, Luigi Benecchi, Cosimo De Nunzio, Riccardo Lombardo, Aldo Brassetti, Gabriele Tuderti, Mariaconsiglia Ferriero, Salvatore Guaglianone, Rocco Simone Flammia, Riccardo Mastroianni, Michele Gallucci, and Giuseppe Simone Umberto Anceschi*Umberto Anceschi* More articles by this author , Luigi BenecchiLuigi Benecchi More articles by this author , Cosimo De NunzioCosimo De Nunzio More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000911.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted radical cystectomy (RARC) with orthotopic neobladder (ON) is associated with heterogeneous surgical, functional and oncological outcomes. We propose a combination of three standardized and reproducible postoperative criteria (Trifecta) to optimize outcomes reporting after RARC with ON and we developed a nomogram to predict probability of achieving trifecta. METHODS: We defined the "trifecta" as the combination of daily urinary continence, no reoperations (meaning neither post-operative complications Clavien-Dindo ≥ 3 nor other surgical interventions related to RARC/ON, after discharge) and recurrence-free status, all assessed at one year. A total of 137 consecutive patients who underwent RARC with intracorporeal ON for bladder cancer were used to generate a nomogram predicting probability of achieving trifecta outcomes. The discrimination accuracy was measured by concordance index (CI). Calibration plot was generated with 200 bootstrap resampling. A decision curve analysis was performed to assess the net benefit of the model. RESULTS: Overall, 137 patients were included in the analysis (Table 1). The trifecta was achieved by 72 (53%) patients. On multivariable logistic regression analysis, age, ASA score, body mass index and neoadjuvant chemotherapy were significant predictors of trifecta achievement. The developed nomogram had a 0.71 CI (Figure 1A) and was well calibrated (Figure 1B); on decision curve analysis, the net benefit of using the model was evident for probabilities ranging between 25% and 70% (Figure 1C). The small sample size and the lack of external validation are the main limitations of this study. CONCLUSIONS: This newly defined trifecta is the first standardized and reproducible system specifically designed to provide a comprehensive summary of global results after RARC-iN. The developed nomogram is an easy clinical tool to predict probability of trifecta achievement at 12-mo follow-up evaluation. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e747-e748 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Anceschi* More articles by this author Luigi Benecchi More articles by this author Cosimo De Nunzio More articles by this author Riccardo Lombardo More articles by this author Aldo Brassetti More articles by this author Gabriele Tuderti More articles by this author Mariaconsiglia Ferriero More articles by this author Salvatore Guaglianone More articles by this author Rocco Simone Flammia More articles by this author Riccardo Mastroianni More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

Topic: Bladder and Urothelial Cancer Treatments
Subfield: Surgery
Field: Medicine
Domain: Health Sciences