A novel risk stratification to predict local-regional failures in urothelial carcinoma of the bladder after radical cystectomy.

• DOI: 10.1200/jco.2012.30.5_suppl.262
• Publication Date: 2017-02-23T18:53:34Z
• Authors: Brian Christopher...; Thomas J. Guzzo; Jiwei He; Stephen Michael K...; Kai Tucker; Justin E. Bekelman; Wei-Ting Hwang; David J. Vaughn; S. Bruce Malkowicz; John Paul Christo...
• Keywords: Lymphovascular invasion; Univariate analysis; T-stage

262 Background: Invasive urothelial bladder carcinoma is typically treated with radical cystectomy (RC) plus pelvic lymph node dissection (PLND) +/− chemotherapy. Local-regional failures (LF) following are a significant problem. Adjuvant radiation therapy (RT) could potentially reduce LF but currently has no defined role because of previously reported morbidity. Modern RT techniques improved normal tissue sparing have rekindled interest in adjuvant RT. Stratifying patients by differing risk facilitate selection for Methods: From 1990–2008, 442 were prospectively followed at the University Pennsylvania after RC+PLND chemotherapy routine CT or MRI. Univariate and multivariate competing analyses identified subgroups risk. Results: On univariate analysis, stage pT3-4, total nodes removed (<10 vs. ≥10), positive margins, nodes, hydronephrosis, lymphovascular invasion, mixed histology predictors LF, while use chemotherapy, number surgical diversion type, age, gender, race, smoking history BMI not. Node density was marginal predictor LF. only ≥pT3-4 (<10) independent hazard ratios 3.17 2.37 respectively (p<0.01). Analysis 3 patient significantly different risk: low-risk (pT0-2), intermediate-risk (pT3-4, ≥10 nodes), high-risk <10 nodes) 5-year rates 8%, 23%, 42% (p <0.01). Conclusions: This study local-regional recurrence factors RC based on largest reported, maintained database follow-up surveillance. varies among subgroups. stratification model future radiotherapy trials.