Multifactorial, site‐specific recurrence model after radical cystectomy for urothelial carcinoma

BACKGROUND: A scoring algorithm of site‐specific disease recurrence after cystectomy for urothelial carcinoma was designed. METHODS: Identified were 1388 patients who underwent radical cystectomy for nonmetastatic urothelial carcinoma between 1980 and 1998. Clinical, surgical, and pathologic feature...

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Published in:Cancer 2010-07, Vol.116 (14), p.3399-3407
Main Authors: Umbreit, Eric C., Crispen, Paul L., Shimko, Mark S., Farmer, Sara A., Blute, Michael L., Frank, Igor
Format: Article
Language:English
Subjects:
Abdominal Neoplasms - secondary
Adult
Aged
Aged, 80 and over
Algorithms
Biological and medical sciences
Bone Neoplasms - secondary
Carcinoma, Transitional Cell - pathology
Carcinoma, Transitional Cell - surgery
cystectomy
Cystectomy - methods
Female
Humans
Male
Medical sciences
Middle Aged
Models, Biological
Pelvic Neoplasms - secondary
Postoperative Period
Recurrence
Risk Assessment
Thoracic Neoplasms - secondary
transitional cell carcinoma
Tumors
Urinary Bladder Neoplasms - pathology
Urinary Bladder Neoplasms - surgery
Urologic Neoplasms - secondary
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Summary:BACKGROUND: A scoring algorithm of site‐specific disease recurrence after cystectomy for urothelial carcinoma was designed. METHODS: Identified were 1388 patients who underwent radical cystectomy for nonmetastatic urothelial carcinoma between 1980 and 1998. Clinical, surgical, and pathologic features were evaluated for associations with 4 locations of site‐specific disease recurrence: upper urinary tract, abdomen/pelvis, thoracic region, and bone. Recurrence‐free survival rates were estimated using the Kaplan‐Meier method. Cox proportional hazards models were fit to test associations with disease recurrence. RESULTS: A total of 493 (35.5%) patients experienced at least 1 recurrence. There were 67, 388, 143, and 145 patients with recurrences to the upper tract, abdomen/pelvis, thoracic region, and bone at a median of 3.1 years, 1.1 years, 1.3 years, and 1.0 years, respectively. Pathologic T4 stage (hazard ratio [HR], 2.84; P = .006), positive ureteral margins (HR, 5.71; P < .001), and multifocality (HR, 2.07; P = .009) were found to be independent predictors of upper tract recurrence. Pathologic T3 (HR, 2.30; P < .001) and T4 stage (HR, 3.55; P < .001), lymph node invasion (HR, 1.97; P < .001), extent of lymphadenectomy (pNx [HR, 1.66; P = .002] and
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.25202