Cancer and All-cause Mortality in Bladder Cancer Patients Undergoing Radical Cystectomy: Development and Validation of a Nomogram for Treatment Decision-making

Williams, Stephen B.; Huo, Jinhai; Chu, Yiyi; Baillargeon, Jacques; Daskivich, Timothy J.; Kuo, Yong Fang; Kosarek, Christopher D.; Kim, Simon P.; Orihuela, Eduardo; Tyler, Douglas S.; Freedland, Stephen J.; Kamat, Ashish M.

doi:10.1016/j.urology.2017.08.024

Cited by 22 publications

(16 citation statements)

References 20 publications

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“…Reflecting previous research and clinical knowledge, we included patients' sociodemographic (age, sex, race/ ethnicity, annual household income, educational level, marital status, and region) and clinical characteristics (comorbidities, stage, and grade) in the propensity score model. 14,19 All independent variables were parameterized, as illustrated in Table 1. We checked collinearity between educational level and income and the interaction among comorbidities, stage, and grade while building the propensity score model.…”

Section: Discussionmentioning

confidence: 99%

Comparing Survival Outcomes and Costs Associated With Radical Cystectomy and Trimodal Therapy for Older Adults With Muscle-Invasive Bladder Cancer

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Comparing Survival Outcomes and Costs Associated With Radical Cystectomy and Trimodal Therapy for Older Adults With Muscle-Invasive Bladder Cancer

et al. 2018

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“…Several nomograms have been proposed in the past, but are currently not implemented in clinical practice (Table S6) [6,7,10,24–26]. Most of these nomograms use more than three variables, or even up to 10 variables, and are difficult to calculate without using their specific chart of the nomogram or calculator [10]. Furthermore, some of the included variables are not relevant in most hospitals: e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Although several nomograms predicting survival after RC have been developed, they are not widely adopted due to their complexity and a high number of included variables [6,7,10]. To simplify the prediction of cancer‐specific survival (CSS) after RC, the COBRA score was developed based on a series of patients ( n = 14 828) from the SEER database in the United States [9].…”

Section: Introductionmentioning

confidence: 99%

The Cancer of the Bladder Risk Assessment (COBRA) score for estimating cancer‐specific survival after radical cystectomy: external validation in a large bi‐institutional cohort

et al. 2020

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Objective To perform an external validation of the Cancer of the Bladder Risk Assessment (COBRA) score for estimating cancer‐specific survival (CSS) after radical cystectomy (RC) in a large bi‐institutional cohort of patients. Patients and Methods Patients treated with RC and lymph node dissection (LND) between May 1996 and July 2017 were retrieved from the RC databases of Leuven and Turin. Collected variables were age at RC, tumour stage, lymph node (LN) density, neoadjuvant chemotherapy, the extent of LND, and nodal stage. The primary outcome was CSS visualised using Kaplan–Meier plots. Cox proportional hazard models were used to assess the impact of variables on CSS. We performed a pairwise comparison between the COBRA score levels using a log‐rank test corrected by Bonferroni, and developed a simplified COBRA score with three risk categories. To compare models, we assessed concordance indices (C‐indices), receiver operating characteristic curves with area under the curve (AUC), calibration plots, and decision curve analysis (DCA). Finally, we compared both COBRA and simplified COBRA models with the established American Joint Committee on Cancer (AJCC) model. Results A total of 812 patients were included. All COBRA score variables had a significant impact on CSS in a Cox proportional hazard model. However, pairwise comparison of the COBRA subscores could not differentiate significantly between all COBRA score levels. Based on these findings, we developed a simplified COBRA score by introducing three categories within the following COBRA score ranges: low‐ (0–1) vs intermediate‐ (2–4) vs high‐risk (5–7). A pairwise comparison could discriminate significantly between all COBRA risk categories. When finally comparing COBRA and simplified COBRA models with the AJCC model, AJCC performed better than both. C‐indices, AUCs, calibration plots and DCA for AJCC were all better compared with the original and simplified COBRA models. Conclusion We performed an external validation of the COBRA score in a large bi‐institutional cohort. We observed that several risk groups had overlapping CSS, demonstrating suboptimal performance of the COBRA score. Therefore, we constructed a simplified model with three COBRA score risk categories. This model resulted in demarcated risk groups with non‐overlapping CSS and good predictive accuracy. However, both COBRA score models were outperformed by the AJCC staging system. Therefore, we conclude that the AJCC staging system should remain the current standard for stratifying patients after RC for CSS.

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“…Comorbidity has been found associated with perioperative death 90-day mortality and 5-year mortality after radical cystectomy [ 13 , 14 ]. Nomograms have been developed and validated predicting all-cause mortality including variables related to age and comorbidity measured by the Charlson score [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy

et al. 2018

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BackgroundRadical cystectomy bears a considerable perioperative mortality risk particularly in elderly patients. In this study, we searched for predictors of perioperative and long-term competing (non-bladder cancer) mortality in elderly patients selected for radical cystectomy.MethodsWe stratified 1184 consecutive patients who underwent radical cystectomy for high risk superficial or muscle-invasive urothelial or undifferentiated carcinoma of bladder into two groups (age < 80 years versus 80 years or older). Multivariable and cox proportional hazards models were used for data analysis.ResultsWhereas Charlson score and the American Society of Anesthesiologists (ASA) physical status classification (but not age) were independent predictors of 90-day mortality in younger patients, only age predicted 90-day mortality in patients aged 80 years or older (odds ratio per year 1.24, p = 0.0422). Unlike in their younger counterparts, neither age nor Charlson score or ASA classification were predictors of long-term competing mortality in patients aged 80 years or older (hazard ratios 1.07-1.10, p values 0.21-0.77).ConclusionsThis data suggest that extrapolations of perioperative mortality or long-term mortality risks of younger patients to octogenarians selected for radical cystectomy should be used with caution. Concerning 90-day mortality, chronological age provided prognostic information whereas comorbidity did not.

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Cancer and All-cause Mortality in Bladder Cancer Patients Undergoing Radical Cystectomy: Development and Validation of a Nomogram for Treatment Decision-making

Cited by 22 publications

References 20 publications

Comparing Survival Outcomes and Costs Associated With Radical Cystectomy and Trimodal Therapy for Older Adults With Muscle-Invasive Bladder Cancer

Comparing Survival Outcomes and Costs Associated With Radical Cystectomy and Trimodal Therapy for Older Adults With Muscle-Invasive Bladder Cancer

The Cancer of the Bladder Risk Assessment (COBRA) score for estimating cancer‐specific survival after radical cystectomy: external validation in a large bi‐institutional cohort

Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy

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