1432 EXTERNAL VALIDATION OF A MULTICENTER PROGNOSTIC MODEL FOR RISK STRATIFICATION IN PT2N0 BLADDER CANCER
2013-03-27

You have accessJournal of UrologyBladder Cancer: Invasive (I)1 Apr 20131432 EXTERNAL VALIDATION OF A MULTICENTER PROGNOSTIC MODEL FOR RISK STRATIFICATION IN PT2N0 BLADDER CANCER Tilman Todenhöfer, Markus Renninger, Bikheet Al-Matar, Mohamed F. Abdelhafez, Arnulf Stenzl, and Georgios Gakis Tilman TodenhöferTilman Todenhöfer Tuebingen, Germany More articles by this author , Markus RenningerMarkus Renninger Tuebingen, Germany More articles by this author , Bikheet Al-MatarBikheet Al-Matar Tuebingen, Germany More articles by this author , Mohamed F. AbdelhafezMohamed F. Abdelhafez Tuebingen, Germany More articles by this author , Arnulf StenzlArnulf Stenzl Tuebingen, Germany More articles by this author , and Georgios GakisGeorgios Gakis Tuebingen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2786AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to externally validate a recently published multicenter-based prognostic model for recurrence-free survival (RFS) in pT2N0 bladder cancer which aims to identify high-risk patients for adjuvant trials. In addition, we aimed to determine whether this prognostic model is superior to the AJCC Staging System for predicting bladder cancer recurrence in pT2N0 disease which is solely based on pT2 substaging (pT2b vs. pT2a). By contrast, this newly proposed model accounts for tumor stage at RC (pT2b vs. pT2a vs. <=pT1; score 4 vs. 2 vs. 0), tumor grade (high vs. low; score 3 vs. 0) and lymphovascular invasion (LVI vs. LV0; score 3 vs. 0) thereby defining three prognostic groups (scoring sum: 0=low, 2-5= intermediate, high=6-10; published c-index: 0.70). METHODS A contemporary, consecutive series of 314 patients undergoing radical cystectomy and bilateral pelvic lymphadenectomy for bladder cancer between 1999-2011 was considered for analysis. Of these, 84 (26.8%) had pT2N0cM0 bladder cancer without neoadjuvant treatment. The median follow-up for patients alive at last CT-scan was 32 months (6-116). Kaplan Meier method was used to estimate recurrence-free survival (RFS) using log-rank test and Cox-proportional hazard analysis for multivariate analysis. The predictive accuracy of the model was calculated by the concordance (c-) index. RESULTS Of the 84 patients, 32 had pT2b (38%), 29 pT2a (35%) and 23 <=pT1 (27%) at RC. Tumors were high-grade in 82 of the 84 patients (98%) and lymphovascular invasion was present in 6 of the 84 patients (7%). The 3-/5-year RFS was 100%/100% in low-risk, 88%/80% in intermediate risk and 48%/19% in high-risk patients (p=0.004; c=0.69). According to the AJCC risk grouping, the 3-/5-year RFS was 89%/71% in pT2aN0 patients and 47%/31% in pT2bN0 patients (p=0.002; c=0.64). In multivariate analysis, there was an increase in the predictive accuracy of the proposed model compared to the AJCC based prediction model by 5.0% (p=0.12). CONCLUSIONS In this single-center validation study, we could confirm the initially published c-index value for the proposed risk grouping of patients with pT2N0 bladder cancer. However, there was only a trend towards significant improvement in the predictive accuracy as compared to the AJCC based predictions which strengthens the prognostic value of substratification in node-negative pT2 disease. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e586-e587 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tilman Todenhöfer Tuebingen, Germany More articles by this author Markus Renninger Tuebingen, Germany More articles by this author Bikheet Al-Matar Tuebingen, Germany More articles by this author Mohamed F. Abdelhafez Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Georgios Gakis Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...