OBJECTIVE: To externally validate currently available bladder cancer nomograms for prediction of all-cause survival (ACS), cancer-specific survival (CSS), other-cause mortality (OCM) and progression-free survival (PFS).
SUBJECTS/METHODS: Retrospective analysis of a prospectively maintained database of 282 patients who underwent robot-assisted radical cystectomy (RARC) at a single institution was performed. The Bladder Cancer Research Consortium (BCRC), International Bladder Cancer Nomogram Consortium (IBCNC) and Lughezzani Nomogram were used for external validation, and evaluation for accuracy at predicting oncologic outcomes. The 2 and 5 year oncological outcomes were compared, and nomogram performance was evaluated through measurement of the concordance (c-index) between nomogram-derived predicted oncologic outcomes and observed oncologic outcomes.
RESULTS: Median patient age was 70 years (36-90). At a mean follow-up of 20 months, local or distant disease recurrence developed in 30% of patients. With an overall mortality rate of 33%, 17% died from bladder cancer. The actuarial 2 and 5-year PFS after RARC was 62% (95% CI 54%-68%) and 55% (95% CI 46%-63%), respectively., The actuarial 2 and 5-year ACS was 66% (95% CI 59%-72%) and 47% (95% CI 37%-55%), respectively, and the 2 and 5-year CSS was 81% (95% CI 74%-86%) and 67% (95% CI 57%-76%), respectively. The PFS c-index for IBCNC was 0.70 at 5 years, and for BCRC was 0.77 at both the 2-year and 5-year time points. Accuracy of ACS and CSS prediction was evaluated using the BCRC and Lughezzani nomograms. Using the BCRC nomogram, c-indices of for 2- and 5-year ACS were each 0.73 and c-indices for 2- and 5-year CSS were 0.70 each. The performance of Lughezzani nomogram for 5-year ACS, CSM and OCM were 0.73, 0.72 and 0.40, respectively. The BCRC nomogram prediction of advanced pathologic stage and lymph node metastasis was modest, with c-indices of 0.66 and 0.61, respectively.
CONCLUSION: Bladder cancer nomograms available from the current open cystectomy literature adequately predict ACS, CSS and PFS following robotic cystectomy. However, prediction of advanced tumor stage and lymph node metastasis was modest and Lughezzani nomogram failed to predict OCM.
Written by:
Al-Daghmin A, English S, Kauffman EC, Din R, Khan A, Syed JR, Sztorc J, Mehedint D, Sharif M, Shi Y, Wilding G, Guru KA. Are you the author?
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
Reference: BJU Int. 2013 Oct 4. Epub ahead of print.
doi: 10.1111/bju.12484
PubMed Abstract
PMID: 24119175
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