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Conditional Survival After Radical Cystectomy for Bladder Cancer: Evidence for a Patient Changing Risk Profile over Time
Authors:Guillaume Ploussard  Shahrokh F. Shariat  Alice Dragomir  Luis A. Kluth  Evanguelos Xylinas  Alexandra Masson-Lecomte  Malte Rieken  Michael Rink  Kazumasa Matsumoto  Eiji Kikuchi  Tobias Klatte  Stephen A. Boorjian  Yair Lotan  Florian Roghmann  Adrian S. Fairey  Yves Fradet  Peter C. Black  Ricardo Rendon  Jonathan Izawa  Wassim Kassouf
Affiliation:1. Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada;2. Department of Urology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France;3. Department of Surgery, Western University, London, ON, Canada;4. Department of Surgery, Laval University, Quebec, QC, Canada;5. Department of Surgery, University of Alberta, Edmonton, AB, Canada;6. Department of Surgery, Dalhousie University, Halifax, NS, Canada;g Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada;h Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA;i Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany;j Department of Urology, University Hospital Basel, Basel, Switzerland;k Department of Urology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France;l Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan;m Department of Urology, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan;n Department of Urology, Ruhr-University Bochum, Marienhospital, Herne, Germany;o Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA;p Department of Urology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Paris Est Créteil University, Créteil, France;q Department of Urology, Medical University of Vienna, Vienna, Austria;r Department of Urology, University of Texas Southwestern Medical Center, Dallas, Dallas, TX, USA
Abstract:

Background

Standard survival statistics do not take into consideration the changes in the weight of individual variables at subsequent times after the diagnosis and initial treatment of bladder cancer.

Objective

To assess the changes in 5-yr conditional survival (CS) rates after radical cystectomy for bladder cancer and to determine how well-established prognostic factors evolve over time.

Design, setting, and participants

We analyzed data from 8141 patients treated with radical cystectomy at 15 international academic centers between 1979 and 2012.

Interventions

Radical cystectomy and pelvic lymph node dissection.

Outcome measurements and statistical analysis

Conditional cancer-specific survival (CSS) and overall survival (OS) estimates were calculated using the Kaplan-Meier method. The multivariable Cox regression model was used to calculate proportional hazard ratios for the prediction of mortality after stratification by clinical characteristics (age, perioperative chemotherapy status) and pathologic characteristics (pT stage, grade, lymphovascular invasion, pN stage, number of nodes removed, margin status). The median follow-up was 32 mo.

Results and limitations

The 5-yr CSS and OS rates were 67.7% and 57.5%, respectively. Given a 1-, 2-, 3-, 5- and 10-yr survivorship, the 5-yr conditional OS rates improved by +5.6 (60.7%), +8.4 (65.8%), +7.6 (70.8%), +3.0 (72.9%), and +1.9% (74.3%), respectively. The 5-yr conditional CSS rates improved by +5.6 (71.5%), +9.8 (78.5%), +7.9 (84.7%), +7.2 (90.8%), and 5.6% (95.9%), respectively. The 5- and 10-yr CS improvement was primarily noted among surviving patients with advanced stage disease. The impact of pathologic parameters on CS estimates decreased over time for both CSS and OS. Findings were confirmed on multivariable analyses. The main limitation was the retrospective design.

Conclusions

CS analysis demonstrates that the patient risk profile changes over time. The risk of mortality decreases with increasing survivorship. The CS rates improve mainly in the case of advanced stage disease. The impact of prognostic pathologic features decreases over time and can disappear for long-term CS.
Keywords:Radical cystectomy   Conditional survival   Bladder cancer   Outcome
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