Conditional survival after radical cystectomy for bladder cancer: Evidence for a patient changing risk profile over time

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

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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.

Original languageEnglish
Pages (from-to)361-370
Number of pages10
JournalEuropean Urology
Volume66
Issue number2
DOIs
Publication statusPublished - 2014

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Keywords

  • Bladder cancer
  • Conditional survival
  • Outcome
  • Radical cystectomy

ASJC Scopus subject areas

  • Urology

Cite this

Ploussard, G., Shariat, S. F., Dragomir, A., Kluth, L. A., Xylinas, E., Masson-Lecomte, A., Rieken, M., Rink, M., Matsumoto, K., Kikuchi, E., Klatte, T., Boorjian, S. A., Lotan, Y., Roghmann, F., Fairey, A. S., Fradet, Y., Black, P. C., Rendon, R., Izawa, J., & Kassouf, W. (2014). Conditional survival after radical cystectomy for bladder cancer: Evidence for a patient changing risk profile over time. European Urology, 66(2), 361-370. https://doi.org/10.1016/j.eururo.2013.09.050