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BJU Int. 2011 Sep;108(5):687-92. doi: 10.1111/j.1464-410X.2010.09902.x. Epub 2010 Nov 19.

Prognostic risk stratification of pathological stage T2N0 bladder cancer after radical cystectomy.

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1
Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. guru.sonpavde@usoncology.com

Abstract

OBJECTIVE:

• To stratify risk of pathological (p) T2N0 urothelial carcinoma of the bladder after radical cystectomy (RC) based on pathological factors to facilitate the development of adjuvant therapy trials for high-risk patients.

PATIENTS AND METHODS:

• The study comprised 707 patients from a database of patients with pT2N0 urothelial carcinoma of the bladder who had undergone RC and not received perioperative chemotherapy. • The effect of residual pT-stage at RC, age, grade, lymphovascular invasion and number of lymph nodes removed on recurrence-free survival was evaluated using Cox regression analyses. A weighted prognostic model was devised with significant variables.

RESULTS:

• The median follow up was 60.9 months. In multivariable analyses, residual disease at RC (pT2a: hazard ratio (HR) 1.740, P = 0.03; for pT2b: HR 3.075, P < 0.001; both compared with <pT2), high-grade (HR 2.127, P = 0.09) and lymphovascular invasion (HR 2.234, P < 0.001) were associated with recurrence-free survival (c = 0.70). • Three risk groups were devised based on weighted variables with 5-year recurrence-free survival of 95% (95% CI 87-98), 86% (95% CI 81-90) and 62% (95% CI 54-69) in the good-risk, intermediate-risk and poor-risk groups, respectively (c = 0.68). The primary limitation is the retrospective and multicenter feature.

CONCLUSIONS:

• A prognostic risk model for patients with pT2N0 bladder cancer undergoing RC with generally adequate lymph node dissection was constructed based on residual pathological stage at RC, grade and lymphovascular invasion. • These data warrant validation and may enable the selection of patients with high-risk pT2N0 urothelial carcinoma of the bladder for adjuvant therapy trials.

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