TY - JOUR
T1 - Conditional survival after radical cystectomy for bladder cancer
T2 - Evidence for a patient changing risk profile over time
AU - Ploussard, Guillaume
AU - Shariat, Shahrokh F.
AU - Dragomir, Alice
AU - Kluth, Luis A.
AU - Xylinas, Evanguelos
AU - Masson-Lecomte, Alexandra
AU - Rieken, Malte
AU - Rink, Michael
AU - Matsumoto, Kazumasa
AU - Kikuchi, Eiji
AU - Klatte, Tobias
AU - Boorjian, Stephen A.
AU - Lotan, Yair
AU - Roghmann, Florian
AU - Fairey, Adrian S.
AU - Fradet, Yves
AU - Black, Peter C.
AU - Rendon, Ricardo
AU - Izawa, Jonathan
AU - Kassouf, Wassim
N1 - Funding Information:
Financial disclosures: Wassim Kassouf certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Wassim Kassouf is a recipient of a Research Scholar Award from the FRSQ. Guillaume Ploussard and Evanguelos Xylinas are recipients of grants from the Association Française d’Urologie.
PY - 2014/8
Y1 - 2014/8
N2 - 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.
AB - 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.
KW - Bladder cancer
KW - Conditional survival
KW - Outcome
KW - Radical cystectomy
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U2 - 10.1016/j.eururo.2013.09.050
DO - 10.1016/j.eururo.2013.09.050
M3 - Article
C2 - 24139235
AN - SCOPUS:84904042826
SN - 0302-2838
VL - 66
SP - 361
EP - 370
JO - European urology
JF - European urology
IS - 2
ER -