Ja Hyeon Ku1, Myong Kim1, Chang Wook Jeong1, Cheol Kwak1, Hyeon Hoe Kim2. 1. Department of Urology, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Urology, Seoul National University College of Medicine, Seoul, Korea. Electronic address: hhkim@snu.ac.kr.
Abstract
PURPOSE: To evaluate the predictive accuracy and general applicability of the locoregional failure model in a different cohort of patients treated with radical cystectomy. METHODS AND MATERIALS: A total of 398 patients were included in the analysis. Death and isolated distant metastasis were considered competing events, and patients without any events were censored at the time of last follow-up. The model included the 3 variables pT classification, the number of lymph nodes identified, and margin status, as follows: low risk (≤pT2), intermediate risk (≥pT3 with ≥10 nodes removed and negative margins), and high risk (≥pT3 with <10 nodes removed or positive margins). RESULTS: The bootstrap-corrected concordance index of the model 5 years after radical cystectomy was 66.2%. When the risk stratification was applied to the validation cohort, the 5-year locoregional failure estimates were 8.3%, 21.2%, and 46.3% for the low-risk, intermediate-risk, and high-risk groups, respectively. The risk of locoregional failure differed significantly between the low-risk and intermediate-risk groups (subhazard ratio [SHR], 2.63; 95% confidence interval [CI], 1.35-5.11; P<.001) and between the low-risk and high-risk groups (SHR, 4.28; 95% CI, 2.17-8.45; P<.001). Although decision curves were appropriately affected by the incidence of the competing risk, decisions about the value of the models are not likely to be affected because the model remains of value over a wide range of threshold probabilities. CONCLUSIONS: The model is not completely accurate, but it demonstrates a modest level of discrimination, adequate calibration, and meaningful net benefit gain for prediction of locoregional failure after radical cystectomy.
PURPOSE: To evaluate the predictive accuracy and general applicability of the locoregional failure model in a different cohort of patients treated with radical cystectomy. METHODS AND MATERIALS: A total of 398 patients were included in the analysis. Death and isolated distant metastasis were considered competing events, and patients without any events were censored at the time of last follow-up. The model included the 3 variables pT classification, the number of lymph nodes identified, and margin status, as follows: low risk (≤pT2), intermediate risk (≥pT3 with ≥10 nodes removed and negative margins), and high risk (≥pT3 with <10 nodes removed or positive margins). RESULTS: The bootstrap-corrected concordance index of the model 5 years after radical cystectomy was 66.2%. When the risk stratification was applied to the validation cohort, the 5-year locoregional failure estimates were 8.3%, 21.2%, and 46.3% for the low-risk, intermediate-risk, and high-risk groups, respectively. The risk of locoregional failure differed significantly between the low-risk and intermediate-risk groups (subhazard ratio [SHR], 2.63; 95% confidence interval [CI], 1.35-5.11; P<.001) and between the low-risk and high-risk groups (SHR, 4.28; 95% CI, 2.17-8.45; P<.001). Although decision curves were appropriately affected by the incidence of the competing risk, decisions about the value of the models are not likely to be affected because the model remains of value over a wide range of threshold probabilities. CONCLUSIONS: The model is not completely accurate, but it demonstrates a modest level of discrimination, adequate calibration, and meaningful net benefit gain for prediction of locoregional failure after radical cystectomy.
Authors: Mohamed S Zaghloul; John P Christodouleas; Andrew Smith; Ahmed Abdallah; Hany William; Hussein M Khaled; Wei-Ting Hwang; Brian C Baumann Journal: JAMA Surg Date: 2018-01-17 Impact factor: 14.766
Authors: Libni J Eapen; Edward Jones; Wassim Kassouf; Carole Lambert; Scott C Morgan; Madeleine Moussa; Robert Nam; Matthew Parliament; Laurie Russell; Fred Saad; D Robert Siemens; Luis Souhami; Ewa Szumacher; Scott Tyldesley; Yan Xu; Ingrid Zbieranowski; Rodney H Breau; Eric Belanger; Peter Black; Eric Estey; Julie Bowan; Bishwajit Bora; Michael Brundage; Peter Chung; Neil Fleshner; Andrew Evans; Glenn Bauman; Jonathan Izawa; Chris Davidson; Fadi Brimo Journal: Can Urol Assoc J Date: 2016 Mar-Apr Impact factor: 1.862
Authors: Brian C Baumann; Jiwei He; Wei-Ting Hwang; Kai N Tucker; Justin E Bekelman; Harry W Herr; Seth P Lerner; Thomas J Guzzo; S Bruce Malkowicz; John P Christodouleas Journal: Int J Radiat Oncol Biol Phys Date: 2016-01-23 Impact factor: 7.038
Authors: Brian C Baumann; Walter R Bosch; Amit Bahl; Alison J Birtle; Rodney H Breau; Amarnath Challapalli; Albert J Chang; Ananya Choudhury; Sia Daneshmand; Ali El-Gayed; Adam Feldman; Steven E Finkelstein; Thomas J Guzzo; Serena Hilman; Ashesh Jani; S Bruce Malkowicz; Constantine A Mantz; Viraj Master; Anita V Mitra; Vedang Murthy; Sima P Porten; Pierre M Richaud; Paul Sargos; Jason A Efstathiou; Libni J Eapen; John P Christodouleas Journal: Int J Radiat Oncol Biol Phys Date: 2016-05-07 Impact factor: 7.038
Authors: Paul Sargos; Brian C Baumann; Libni J Eapen; Amit Bahl; Vedang Murthy; Guilhem Roubaud; Mathieu Orré; Jason A Efstathiou; Shahrokh Shariat; Stephane Larré; Pierre Richaud; John P Christodouleas Journal: Transl Androl Urol Date: 2016-10
Authors: Brian C Baumann; Paul Sargos; Libni J Eapen; Jason A Efstathiou; Ananya Choudhury; Amit Bahl; Vedang Murthy; Leslie K Ballas; Valérie Fonteyne; Pierre M Richaud; Mohamed S Zaghloul; John P Christodouleas Journal: Bladder Cancer Date: 2017-01-27