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• W2022987453 abstract "You have accessJournal of UrologyBladder Cancer: Invasive (II)1 Apr 20131628 RISK STRATIFICATION FOR LOCAL-REGIONAL FAILURE AFTER CYSTECTOMY Brian Baumann, Jiwei He, Wei-Ting Hwang, Kai Tucker, Seth Lerner, Cathy Tangen, Harry Herr, Thomas Guzzo, S. Bruce Malkowicz, and John Christodouleas Brian BaumannBrian Baumann Philadelphia, PA More articles by this author , Jiwei HeJiwei He Philadelphia, PA More articles by this author , Wei-Ting HwangWei-Ting Hwang Philadelphia, PA More articles by this author , Kai TuckerKai Tucker Philadelphia, PA More articles by this author , Seth LernerSeth Lerner Houston, TX More articles by this author , Cathy TangenCathy Tangen Seattle, WA More articles by this author , Harry HerrHarry Herr New York, NY More articles by this author , Thomas GuzzoThomas Guzzo Philadelphia, PA More articles by this author , S. Bruce MalkowiczS. Bruce Malkowicz Philadelphia, PA More articles by this author , and John ChristodouleasJohn Christodouleas Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3178AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several organizations are designing trials to study adjuvant radiation (RT) after radical cystectomy and pelvic lymph node dissection (RC) +/− chemotherapy for bladder cancer, but patients most likely to benefit from RT have not been clearly identified. This study's purpose was to evaluate and refine a recently published risk stratification model for local-regional failure (LF) by applying it to a multi-center patient cohort. METHODS The original stratification was derived from 442 patients treated with RC +/− chemotherapy at the University of Pennsylvania (PENN) between 1990 - 2008 who were prospectively followed with routine pelvic CT or MRI. Analysis identified 3 patient subgroups with significantly different LF risk based on pathologic stage (pT) and number of nodes dissected. This risk rubric was then applied to 264 patients treated with RC +/− chemotherapy in SWOG 8710, a multi-center randomized trial. In both cohorts, LF was scored as any pelvic failure detected before or within 3 months of distant failure. Competing risk analysis was used. RESULTS SWOG patients differed significantly from PENN patients in mean age, pT stage, number of nodes removed, surgical margin status, and use of neoadjuvant chemotherapy (p<0.01 for all comparisons). The original risk stratification was not fully validated in the SWOG cohort who had less pronounced LF differences in ≥pT3 patients who had ≥10 versus <10 nodes removed. Regression analysis of the SWOG data suggested margin status was a more important stratifying variable than number of nodes dissected. A revised risk stratification using pT stage, margin status, and number of nodes removed identified 3 subgroups in both SWOG and PENN cohorts with significantly different LF risk: low (≤pT2), intermediate (≥pT3, negative margins AND ≥10 nodes removed), and high (≥pT3 with positive margins OR <10 nodes removed) with 5 year LF rates of 8%, 20% & 41% in the SWOG group and 8%, 19% & 41% in the PENN cohort (Figure). Gray's test p<0.01 and C-index was 0.7 for the risk stratification model for both cohorts. CONCLUSIONS The revised risk grouping combining pT stage, margin status and number of nodes excised stratified LF risk in two significantly different bladder cancer populations and may inform selection of patients for adjuvant RT trials. External validation of this revised stratification rubric is warranted. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e669-e670 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Baumann Philadelphia, PA More articles by this author Jiwei He Philadelphia, PA More articles by this author Wei-Ting Hwang Philadelphia, PA More articles by this author Kai Tucker Philadelphia, PA More articles by this author Seth Lerner Houston, TX More articles by this author Cathy Tangen Seattle, WA More articles by this author Harry Herr New York, NY More articles by this author Thomas Guzzo Philadelphia, PA More articles by this author S. Bruce Malkowicz Philadelphia, PA More articles by this author John Christodouleas Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2022987453 title "1628 RISK STRATIFICATION FOR LOCAL-REGIONAL FAILURE AFTER CYSTECTOMY" @default.
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