Conditional survival after radical cystectomy for bladder cancer: evidence for a patient changing risk profile over time
- PMID: 24139235
- DOI: 10.1016/j.eururo.2013.09.050
Conditional survival after radical cystectomy for bladder cancer: evidence for a patient changing risk profile over time
Abstract
Background: Standard survival statistics do not take into consideration the changes in the weight of individual variables at subsequent times after the diagnosis and initial treatment of bladder cancer.
Objective: To assess the changes in 5-yr conditional survival (CS) rates after radical cystectomy for bladder cancer and to determine how well-established prognostic factors evolve over time.
Design, setting, and participants: We analyzed data from 8141 patients treated with radical cystectomy at 15 international academic centers between 1979 and 2012.
Interventions: Radical cystectomy and pelvic lymph node dissection.
Outcome measurements and statistical analysis: Conditional cancer-specific survival (CSS) and overall survival (OS) estimates were calculated using the Kaplan-Meier method. The multivariable Cox regression model was used to calculate proportional hazard ratios for the prediction of mortality after stratification by clinical characteristics (age, perioperative chemotherapy status) and pathologic characteristics (pT stage, grade, lymphovascular invasion, pN stage, number of nodes removed, margin status). The median follow-up was 32 mo.
Results and limitations: The 5-yr CSS and OS rates were 67.7% and 57.5%, respectively. Given a 1-, 2-, 3-, 5- and 10-yr survivorship, the 5-yr conditional OS rates improved by +5.6 (60.7%), +8.4 (65.8%), +7.6 (70.8%), +3.0 (72.9%), and +1.9% (74.3%), respectively. The 5-yr conditional CSS rates improved by +5.6 (71.5%), +9.8 (78.5%), +7.9 (84.7%), +7.2 (90.8%), and 5.6% (95.9%), respectively. The 5- and 10-yr CS improvement was primarily noted among surviving patients with advanced stage disease. The impact of pathologic parameters on CS estimates decreased over time for both CSS and OS. Findings were confirmed on multivariable analyses. The main limitation was the retrospective design.
Conclusions: CS analysis demonstrates that the patient risk profile changes over time. The risk of mortality decreases with increasing survivorship. The CS rates improve mainly in the case of advanced stage disease. The impact of prognostic pathologic features decreases over time and can disappear for long-term CS.
Keywords: Bladder cancer; Conditional survival; Outcome; Radical cystectomy.
Copyright © 2013. Published by Elsevier B.V.
Comment in
-
Re: Conditional Survival after Radical Cystectomy for Bladder Cancer: Evidence for a Patient Changing Risk Profile over Time.J Urol. 2016 Mar;195(3):610-1. doi: 10.1016/j.juro.2015.12.003. Epub 2015 Dec 10. J Urol. 2016. PMID: 26887704 No abstract available.
Similar articles
-
Oncologic outcomes following robot-assisted radical cystectomy with minimum 5-year follow-up: the Roswell Park cancer institute experience.Eur Urol. 2014 Nov;66(5):920-8. doi: 10.1016/j.eururo.2014.03.015. Epub 2014 Apr 16. Eur Urol. 2014. PMID: 24768522
-
Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis.Eur Urol. 2013 Nov;64(5):837-45. doi: 10.1016/j.eururo.2012.07.026. Epub 2012 Jul 20. Eur Urol. 2013. PMID: 22877503
-
Prospective evaluation of a molecular marker panel for prediction of recurrence and cancer-specific survival after radical cystectomy.Eur Urol. 2013 Sep;64(3):465-71. doi: 10.1016/j.eururo.2013.03.043. Epub 2013 Apr 3. Eur Urol. 2013. PMID: 23571005
-
Malignant urachal neoplasms: A population-based study and systematic review of literature.Urol Oncol. 2017 Jan;35(1):33.e11-33.e19. doi: 10.1016/j.urolonc.2016.07.021. Epub 2016 Sep 1. Urol Oncol. 2017. PMID: 27592530 Review.
-
Comparison of the prognosis of primary and progressive muscle-invasive bladder cancer after radical cystectomy: A systematic review and meta-analysis.Int J Surg. 2018 Apr;52:214-220. doi: 10.1016/j.ijsu.2018.02.049. Epub 2018 Feb 27. Int J Surg. 2018. PMID: 29496649 Review.
Cited by
-
Management of muscle invasive, locally advanced and metastatic urothelial carcinoma of the bladder: a literature review with emphasis on the role of surgery.Transl Androl Urol. 2016 Oct;5(5):735-744. doi: 10.21037/tau.2016.08.23. Transl Androl Urol. 2016. PMID: 27785430 Free PMC article. Review.
-
Machine Learning Quantified Tumor-Stroma Ratio Is an Independent Prognosticator in Muscle-Invasive Bladder Cancer.Int J Mol Sci. 2023 Feb 1;24(3):2746. doi: 10.3390/ijms24032746. Int J Mol Sci. 2023. PMID: 36769068 Free PMC article.
-
Neoadjuvant immunotherapy for muscle invasive urothelial bladder carcinoma: will it change current standards?Ther Adv Urol. 2021 Jul 8;13:17562872211029779. doi: 10.1177/17562872211029779. eCollection 2021 Jan-Dec. Ther Adv Urol. 2021. PMID: 34290827 Free PMC article. Review.
-
A greater number of dissected lymph nodes is associated with more favorable outcomes in bladder cancer treated by radical cystectomy: a meta-analysis.Oncotarget. 2016 Sep 20;7(38):61284-61294. doi: 10.18632/oncotarget.11343. Oncotarget. 2016. PMID: 27542252 Free PMC article.
-
TNM staging towards a personalized approach in metastatic urothelial carcinoma: what will the future be like?-a narrative review.Transl Androl Urol. 2021 Mar;10(3):1541-1552. doi: 10.21037/tau-20-1109. Transl Androl Urol. 2021. PMID: 33850788 Free PMC article. Review.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical