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Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder

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Abstract

Purpose

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.

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Acknowledgments

We would like to thank the following colleagues for their valuable effort in the acquisition of data within our collaborative research group PROMETRICS 2011: Georg Bartsch, Christian Bolenz, Alexander Buchner, Sabine Brookman-May, Melanie Durschnabel, Jörg Ellinger, Galia Georgieva, Christian Gilfrich, Murat Gördük, Marc-Oliver Grimm, Boris Hadaschik, Florian Hartmann, Edwin Herrmann, Lothar Hertle, Markus Hohenfellner, Georg Janetschek, Nicole Kraischits, Annerose Krausse, Lukas Lusuardi, Thomas Martini, Roman Mayr, Maurice Stephan Michel, Rudolf Moritz, Stefan C. Müller, Sascha Pahernik, Armin Pycha, Jan Roigas, Christian Seitz, Shahrokh F. Shariat, Isabella Syring, Lutz Trojan, Florian Wagenlehner, Wolfgang Weidner, Manfred P. Wirth.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study

Author information

Authors and Affiliations

  1. Department of Urology, University Hospital “Carl Gustav Carus”, Dresden, Germany

    Vladimir Novotny, Michael Froehner & Stefan Propping

  2. Department of Urology, St. Elisabeth Hospital, Straubing, Germany

    Matthias May

  3. Department of Urology, University Medical Center Rostock, Rostock, Germany

    Chris Protzel, Katrin Hergenröther & Oliver W. Hakenberg

  4. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Michael Rink, Felix K. Chun, Margit Fisch & Atiqullah Aziz

  5. Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany

    Florian Roghmann, Rein-Jüri Palisaar & Joachim Noldus

  6. Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany

    Michael Gierth, Hans-Martin Fritsche & Maximilian Burger

  7. Department of Urology, University Hospital Erlangen, Erlangen, Germany

    Danijel Sikic, Bastian Keck & Bernd Wullich

  8. Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany

    Philipp Nuhn, Alexander Buchner & Christian G. Stief

  9. Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany

    Stefan Vallo, Georg Bartsch & Axel Haferkamp

  10. Department of Urology, Paracelsus Medical Center Golzheim, Düsseldorf, Germany

    Patrick J. Bastian

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  1. Vladimir Novotny
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  2. Michael Froehner
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  3. Matthias May
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  8. Margit Fisch
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  14. Maximilian Burger
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  15. Danijel Sikic
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  16. Bastian Keck
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  18. Philipp Nuhn
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  19. Alexander Buchner
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  20. Christian G. Stief
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  22. Georg Bartsch
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  24. Patrick J. Bastian
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  25. Oliver W. Hakenberg
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  27. Atiqullah Aziz
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Corresponding author

Correspondence to Atiqullah Aziz.

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Novotny, V., Froehner, M., May, M. et al. Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder. World J Urol 33, 1753–1761 (2015). https://doi.org/10.1007/s00345-015-1502-y

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  • DOI: https://doi.org/10.1007/s00345-015-1502-y

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