Atiqullah Aziz1, Shahrokh F Shariat2, Florian Roghmann3, Sabine Brookman-May4, Christian G Stief4, Michael Rink1, Felix K Chun1, Margit Fisch1, Vladimir Novotny5, Michael Froehner5, Manfred P Wirth5, Marco J Schnabel6, Hans-Martin Fritsche6, Maximilian Burger6, Armin Pycha7, Antonin Brisuda8, Marko Babjuk8, Stefan Vallo9, Axel Haferkamp9, Jan Roigas10, Joachim Noldus3, Regina Stredele11, Björn Volkmer11, Patrick J Bastian12, Evanguelos Xylinas13, Matthias May14. 1. Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Urology, Medical University Vienna, Vienna, Austria. 3. Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany. 4. Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany. 5. Department of Urology, University Hospital 'Carl Gustav Carus', Dresden Technical University, Dresden, Germany. 6. Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany. 7. Department of Urology, General Hospital of Bolzano, Bolzano, Italy. 8. Department of Urology, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic. 9. Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany. 10. Department of Urology, Vivantes Medical Centre im Friedrichshain and am Urban, Berlin, Germany. 11. Department of Urology, Kassel Medical Centre, Kassel, Germany. 12. Department of Urology, Paracelsus Medical Centre Golzheim, Düsseldorf, Germany. 13. Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France. 14. Department of Urology, St. Elisabeth Medical Centre Straubing, Straubing, Germany.
Abstract
OBJECTIVE: To externally validate the pT4a-specific risk model for cancer-specific survival (CSS) proposed by May et al. (Urol Oncol 2013; 31: 1141-1147) and to develop a new pT4a-specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) PATIENTS AND METHODS: Data from 856 patients with pT4a UCB treated with RC at 21 centres in Europe and North-America were assessed. The risk model proposed by May et al., which includes female gender, presence of positive lymphovascular invasion (LVI) and lack of adjuvant chemotherapy administration as adverse predictors for CSS, was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver-operating characteristic-derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinicopathological variables on CSS. Decision-curve analyses were applied to determine the net benefit derived from the two models. RESULTS: The estimated 5-year-CSS after RC was 34% in our cohort. The risk model devised by May et al. predicted individual 5-year-CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (hazard ratio [HR] 1.45), LVI (HR 1.37), lymph node metastases (HR 2.54), positive soft tissue surgical margins (HR 1.39), neoadjuvant (HR 2.24) and lack of adjuvant chemotherapy (HR 1.67, all P < 0.05) were independent predictors of an adverse CSS rate and formed the features of our nomogram with a predictive accuracy of 67.1%. Decision-curve analyses showed higher net benefits for the use of the newly developed nomogram in our cohort over all thresholds. CONCLUSIONS: The risk model devised by May et al. was validated with moderate discrimination and was outperformed by our newly developed pT4a-specific nomogram in the present study population. Our nomogram might be particularly suitable for postoperative patient counselling in the heterogeneous cohort of patients with pT4a UCB.
OBJECTIVE: To externally validate the pT4a-specific risk model for cancer-specific survival (CSS) proposed by May et al. (Urol Oncol 2013; 31: 1141-1147) and to develop a new pT4a-specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) PATIENTS AND METHODS: Data from 856 patients with pT4a UCB treated with RC at 21 centres in Europe and North-America were assessed. The risk model proposed by May et al., which includes female gender, presence of positive lymphovascular invasion (LVI) and lack of adjuvant chemotherapy administration as adverse predictors for CSS, was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver-operating characteristic-derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinicopathological variables on CSS. Decision-curve analyses were applied to determine the net benefit derived from the two models. RESULTS: The estimated 5-year-CSS after RC was 34% in our cohort. The risk model devised by May et al. predicted individual 5-year-CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (hazard ratio [HR] 1.45), LVI (HR 1.37), lymph node metastases (HR 2.54), positive soft tissue surgical margins (HR 1.39), neoadjuvant (HR 2.24) and lack of adjuvant chemotherapy (HR 1.67, all P < 0.05) were independent predictors of an adverse CSS rate and formed the features of our nomogram with a predictive accuracy of 67.1%. Decision-curve analyses showed higher net benefits for the use of the newly developed nomogram in our cohort over all thresholds. CONCLUSIONS: The risk model devised by May et al. was validated with moderate discrimination and was outperformed by our newly developed pT4a-specific nomogram in the present study population. Our nomogram might be particularly suitable for postoperative patient counselling in the heterogeneous cohort of patients with pT4a UCB.
Authors: Marco Moschini; Francesco Soria; Martin Susani; Stephan Korn; Alberto Briganti; Morgan Roupret; Christian Seitz; Killian Gust; Andrea Haitel; Francesco Montorsi; Gregory Wirth; Brian D Robinson; Pierre I Karakiewicz; Mehmet Özsoy; Michael Rink; Shahrokh F Shariat Journal: Bladder Cancer Date: 2017-07-27
Authors: Maria E Aguirre; Hector Leyva-Jimenez; Ryan Travis; Jason T Lee; Giridhar Athrey; Christine Z Alvarado Journal: Poult Sci Date: 2020-04-15 Impact factor: 3.352