Prognostic Risk Stratification of Patients with Urothelial Carcinoma of the Bladder with Recurrence After Radical Cystectomy

Nakagawa, Tohru; Hara, Tomohiko; Kawahara, Takashi; Ogata, Yoshihiko; Nakanishi, Hiroyuki; Komiyama, Motokiyo; Arai, Eri; Kanai, Yae; Fujimoto, Hiroyuki

doi:10.1016/j.juro.2012.10.065

Cited by 51 publications

(44 citation statements)

References 19 publications

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“…In addition to serum ALP reported by von der Maase et al (5), the recent report by Nakagawa et al (11) demonstrated that serum CRP and serum lactate dehydrogenase (LDH) levels were independent predictors of poorer survival, analyzing 114 patients who were treated with radical cystectomy for urothelial bladder carcinoma and subsequently developed metastases (11). Our study has shown that leukocyte counts 8000/ml was a significant risk factor on multivariate analysis, while the elevation of ALP, LDH or CRP was not.…”

Section: Discussionmentioning

confidence: 82%

“…The study also concluded that surgery should be avoided in cases with multiple liver metastases, as well as metastases involving more than one visceral site or abdominal organ, or bone metastases, especially involving the pelvis or axial skeleton (14,15). More recently, Nakagawa et al (11) showed that patients with solitary lung metastasis, long duration from radical surgery to recurrence, no neoadjuvant/adjuvant chemotherapy, no symptom and low CRP level were most likely to benefit from metastasectomy. Our study also showed that focal treatment for metastatic lesions was a statistically significant factor for better outcome.…”

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confidence: 99%

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Prognostic Factors for Metastatic Urothelial Carcinoma Undergoing Cisplatin-based Salvage Chemotherapy

Taguchi

Nakagawa

Hattori

et al. 2013

Japanese Journal of Clinical Oncology

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Objective: To assess the clinicopathologic factors influencing survival in patients with metastatic urothelial carcinoma undergoing salvage chemotherapy. Methods: A retrospective review was conducted on cases of metastatic urothelial carcinoma who underwent cisplatin-based salvage chemotherapy at our institution between April 2003 and July 2011. The association of various clinicopathologic factors with survival was assessed. Survival curves were constructed by the Kaplan -Meier method. A log-rank test for univariate analysis and a Cox proportional hazards model for multivariate analysis were used. Results: Eighty-three cases were identified in the study. Among them, 64 patients were dead during the follow-up. The median survival was 14.6 months. Multivariate analysis evaluating variables at the start of chemotherapy demonstrated that liver metastasis, performance status score 2 and leukocyte counts 8000/ml were significant predictive factors for poor outcome. Based on these three pre-induction variables, a risk model predicting the overall survival from the initiation of chemotherapy was constructed, which classified patients into three groups with significantly different overall survival (P , 0.0001). Additionally, factors after induction of chemotherapy were studied, and poor response for chemotherapy and absence of focal treatment for metastatic lesions were also significantly associated with poorer survival. Conclusions: Liver metastasis, poor performance status and higher leukocyte counts were independent poor prognostic indicators for metastatic urothelial carcinoma. Our risk classification enables an accurate prediction of survival that can be useful in deciding which patients are likely to benefit from salvage chemotherapy.

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Section: Discussionmentioning

confidence: 82%

mentioning

confidence: 99%

Prognostic Factors for Metastatic Urothelial Carcinoma Undergoing Cisplatin-based Salvage Chemotherapy

Taguchi

Nakagawa

Hattori

et al. 2013

Japanese Journal of Clinical Oncology

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“…Early recurrence was defined as tumor recurrence within 12 months after RC. The type of recurrence was classified as local or distant disease [5,6]. The time of death was verified by local cancer registries and by the treating physician.…”

Section: Methodsmentioning

confidence: 99%

“…Despite this aggressive treatment, subsequent disease recurrence occurs in approximately half of patients with muscle-invasive bladder cancer in the first 24 months after RC [1,3]. Over two thirds of patients with disease recurrence die within 1 year of recurrence [4,5]. Various clinicopathological parameters have been identified as predictors of overall survival (OS) in patients who experience disease recurrence after RC [4].…”

Section: Introductionmentioning

confidence: 99%

“…Various clinicopathological parameters have been identified as predictors of overall survival (OS) in patients who experience disease recurrence after RC [4]. In particular, systemic inflammatory parameters, symptoms at recurrence, and a shorter time to recurrence have been described to be independent predictors of OS after recurrence [4,5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

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The Charlson Comorbidity Index Predicts Survival after Disease Recurrence in Patients following Radical Cystectomy for Urothelial Carcinoma of the Bladder

et al. 2014

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Objective: To identify prognostic clinical and histopathological parameters, including comorbidity indices at the time of radical cystectomy (RC), for overall survival (OS) after recurrence following RC for urothelial carcinoma of the bladder (UCB). Materials and Methods: A retrospective multicenter study was carried out in 555 unselected consecutive patients who underwent RC with pelvic lymph node dissection for UCB from 2000 to 2010. A total of 227 patients with recurrence comprised our study group. Cox proportional hazards regression models were calculated with established variables to assess their independent influence on OS after recurrence. Results: The median time from RC to recurrence and the median OS after recurrence was 10.9 and 5.4 months, respectively. Neither the time to recurrence nor the type of recurrence (systematic vs. local) was predictive of the OS. In contrast, age (hazard ratio (HR) 1.53, p = 0.011), lymph node metastasis (HR 1.56, p = 0.007), and positive surgical margins (HR 1.53, p = 0.046) significantly affected the OS after disease recurrence. In addition, the dichotomized Charlson comorbidity index (CCI; dichotomized into >2 vs. 0-2) was the only comorbidity score with an independent prediction of OS (HR 1.41, p = 0.033). We observed a significant gain in the base model's predictive accuracy, i.e. from 68.4 to 70.3% (p < 0.001), after inclusion of the dichotomized CCI. Conclusions: We present the first outcome study of comorbidity indices used as predictors of OS after disease recurrence in patients undergoing RC for UCB. The CCI at the time of RC had no significant influence on the time to recurrence but represented an independent predictor of OS after disease recurrence.

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Is preoperative serum lactate dehydrogenase useful in predicting the outcomes of patients with upper tract urothelial carcinoma?

et al. 2018

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BackgroundLactate dehydrogenase (LDH) has been proved to be associated with clinical outcomes in various carcinomas; however, limited evidence was available in upper urinary tract urothelial carcinoma (UTUC). Thus, the aim of this study was to evaluate the prognostic impact of LDH in UTUC.Patients and methodsA cohort of 668 patients WERE retrospectively included between 2003 and 2016. Kaplan‐Meier method and Cox proportional hazards regression models were used to evaluate the association of LDH with overall survival (OS), cancer‐specific survival (CSS), disease recurrence‐free survival (RFS), and metastasis‐free survival (MFS). The cutoff level of LDH was set at 220 U/L for the upper limit of normal.ResultsKaplan‐Meier plots showed the group with elevated LDH had significant poor OS (P = 0.003), CSS (P = 0.005), and RFS (P = 0.005), but not MFS (P = 0.099). However, multivariate Cox analysis suggested that LDH was not an independent predictor for CSS (HR 1.50, 95%CI: 0.87‐2.59), OS (HR 1.56, 95%CI: 0.94‐2.58), RFS (HR 1.33, 95%CI: 0.83‐2.12), or MFS (HR 1.16, 95%CI: 0.79‐1.71). Albumin, globulin, and HBDH were also not related to survival outcomes of UTUC patients in multivariate analysis, while higher alkaline phosphatase was associated with worse CSS and OS, and higher white blood cells contributed to poor CSS and RFS. In subgroup analysis, results found higher LDH was associated with poor OS in patients with localized disease (pT ≤ 2) (HR 4.03, 95%CI: 1.37‐11.88).ConclusionThe preoperative LDH was not an independent prognostic factor for patients with UTUC, while elevated LDH was proved to be correlated with worse OS in patients with localized disease.

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Prognostic Risk Stratification of Patients with Urothelial Carcinoma of the Bladder with Recurrence After Radical Cystectomy

Cited by 51 publications

References 19 publications

Prognostic Factors for Metastatic Urothelial Carcinoma Undergoing Cisplatin-based Salvage Chemotherapy

Prognostic Factors for Metastatic Urothelial Carcinoma Undergoing Cisplatin-based Salvage Chemotherapy

The Charlson Comorbidity Index Predicts Survival after Disease Recurrence in Patients following Radical Cystectomy for Urothelial Carcinoma of the Bladder

Is preoperative serum lactate dehydrogenase useful in predicting the outcomes of patients with upper tract urothelial carcinoma?

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