The Cancer of the Bladder Risk Assessment (COBRA) score: Estimating mortality after radical cystectomy

Welty, Christopher J.; Sanford, Thomas; Wright, Jonathan L.; Carroll, Peter R.; Cooperberg, Matthew R.; Meng, Maxwell V.; Porten, Sima P.

doi:10.1002/cncr.30918

Cited by 42 publications

(50 citation statements)

References 32 publications

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“…A prior study of UC reported no gender differences in the histopathological characteristics of the tumor [ 25 ]. And more recently, Welty et al developed a new nomogram to predict UC survival following surgery, based on the tumor characteristics, and did not include sex as a prognostic factor [ 4 ]. Our study is the first to investigate gender differences in the grade or the stage of the SCC type.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, to predict recurrence of bladder cancer after surgery, the International Bladder Cancer Nomogram Consortium (IBCNC) developed a tool that includes, among other variables, sex, cancer histological type, and characteristics, as prognostic factors [ 3 ]. However, Welty et al developed a nomogram to predict survival after cystectomy for urothelial cell carcinoma, but did not include sex, because they found age and tumor stage to be considerably stronger risk factors than sex in predicting patient survival [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Urinary Bladder Cancer in Egypt: Are There Gender Differences in Its Histopathological Presentation?

Kyritsi

Loffredo

Zheng

et al. 2018

Advances in Urology

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We investigated gender differences in the histopathologic presentation of bladder cancer cases in Egypt, where both urothelial cell carcinoma (UC) and squamous cell carcinoma (SCC) types are highly prevalent. We used logistic regression to estimate the unadjusted (OR) and adjusted odds ratio (AOR) and 95% confidence interval (CI) of the associations between gender and different histopathologic and sociodemographic parameters of 2,186 confirmed cases of primary bladder cancer (1,775 males and 411 females; 784 SCC and 1,402 UC). There were no statistically significant gender differences in tumor grade, stage, mucosal ulcer, or inflammatory cystitis, regardless of the cancer type, but men were less likely than women to have undergone cystectomy with pelvic lymphadenectomy. Having Schistosoma haematobium (SH) ova in the bladder tissue was significantly associated with male gender in the fully adjusted model of either SCC (AOR (95% CI) = 2.12 (1.15–3.89)) or UC cases (3.78 (1.89–7.55)). Compared to females, male cases were significantly older at time of diagnosis and smokers. In Egypt, regardless of the type of bladder cancer (SCC or UC), male more than female cases had evidence of SH infection, but not other histopathologic differences, in bladder tissue specimens.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Urinary Bladder Cancer in Egypt: Are There Gender Differences in Its Histopathological Presentation?

Kyritsi

Loffredo

Zheng

et al. 2018

Advances in Urology

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“…Furthermore, lymph node (LN) density has been identified as a better prognostic marker than nodal staging, and is calculated by dividing the total number of positive resected LNs by the total number of resected LNs [6–8]. The Cancer of the Bladder Risk Assessment (COBRA) score was developed to predict cancer‐specific mortality (CSM) after surgery and was based on the Surveillance, Epidemiology, and End Results (SEER) cancer database [9]. The COBRA score is calculated using three variables: age at RC, tumour stage, and LN density.…”

Section: Introductionmentioning

confidence: 99%

“…The COBRA score is calculated using three variables: age at RC, tumour stage, and LN density. The COBRA score ranges from 0 to 7, and each point increase is associated with a 1.61‐fold increase (95% CI 1.56–1.65) in the risk of CSM [9]. The COBRA score can be used to counsel patients more adequately on their cancer‐specific prognosis after RC.…”

Section: Introductionmentioning

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]. One of the differences with the other nomograms is the inclusion of LN density as a parameter instead of the nodal stage based on the American Joint Committee on Cancer (AJCC) LN status, which has low prognostic value because it does not account for the positive nodal burden of a patient [8].…”

Section: Introductionmentioning

confidence: 99%

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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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Development and validation of a prognostic nomogram for predicting cancer‐specific survival after radical cystectomy in patients with bladder cancer:A population‐based study

Yang

Bai

Liu³

et al. 2020

Cancer Medicine

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The Cancer of the Bladder Risk Assessment (COBRA) score: Estimating mortality after radical cystectomy

Abstract: The COBRA score offers a straightforward, validated risk-stratification tool that incorporates the relative contribution of tumor stage and lymph node involvement to patient prognosis after cystectomy for UCB. Cancer 2017;123:4574-4582. © 2017 American Cancer Society.

Cited by 42 publications

References 32 publications

Urinary Bladder Cancer in Egypt: Are There Gender Differences in Its Histopathological Presentation?

Urinary Bladder Cancer in Egypt: Are There Gender Differences in Its Histopathological Presentation?

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

Development and validation of a prognostic nomogram for predicting cancer‐specific survival after radical cystectomy in patients with bladder cancer:A population‐based study

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