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dc.contributor.authorMcGrath, John S
dc.contributor.authorAning, J.
dc.date.accessioned2021-02-22T13:01:15Z
dc.date.available2021-02-22T13:01:15Z
dc.date.issued2020-08-05
dc.identifier.citationMir MC et al. Nomogram Predicting Bladder Cancer-specific Mortality After Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle-invasive Bladder Cancer: Results of an International Consortium. Eur Urol Focus. 2020 Aug 5:S2405-4569(20)30208-X.en_US
dc.identifier.pmid32771446
dc.identifier.doi10.1016/j.euf.2020.07.002
dc.identifier.urihttps://rde.dspace-express.com/handle/11287/621625
dc.description.abstractBackground: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) is associated with improved overall and cancer-specific survival. The post-NAC pathological stage has previously been reported to be a major determinant of outcome. Objective: To develop a postoperative nomogram for survival based on pathological and clinical parameters from an international consortium. Design, setting, and participants: Between 2000 and 2015, 1866 patients with MIBC were treated at 19 institutions in the USA, Canada, and Europe. Analysis was limited to 640 patients with adequate follow-up who had received three or more cycles of NAC. Outcome measurements and statistical analysis: A nomogram for bladder cancer-specific mortality (BCSM) was developed by multivariable Cox regression analysis. Decision curve analysis was used to assess the model's clinical utility. Results and limitations: A total of 640 patients were identified. Downstaging to non-MIBC (ypT1, ypTa, and ypTis) occurred in 271 patients (42 %), and 113 (17 %) achieved a complete response (ypT0N0). The 5-yr BCSM was 47.2 % (95 % confidence interval [CI]: 41.2-52.6 %). On multivariable analysis, covariates with a statistically significant association with BCSM were lymph node metastasis (hazard ratio [HR] 1.90 [95% CI: 1.4-2.6]; p < 0.001), positive surgical margins (HR 2.01 [95 % CI: 1.3-2.9]; p < 0.001), and pathological stage (with ypT0/Tis/Ta/T1 as reference: ypT2 [HR 2.77 {95 % CI: 1.7-4.6}; p < 0.001] and ypT3-4 [HR 5.9 {95 % CI: 3.8-9.3}; p < 0.001]). The area under the curve of the model predicting 5-yr BCSM after cross validation with 300 bootstraps was 75.4 % (95 % CI: 68.1-82.6 %). Decision curve analyses showed a modest net benefit for the use of the BCSM nomogram in the current cohort compared with the use of American Joint Committee on Cancer staging alone. Limitations include the retrospective study design and the lack of central pathology. Conclusions: We have developed and internally validated a nomogram predicting BCSM after NAC and radical cystectomy for MIBC. The nomogram will be useful for patient counseling and in the identification of patients at high risk for BCSM suitable for enrollment in clinical trials of adjuvant therapy. Patient summary: In this report, we looked at the outcomes of patients with muscle-invasive bladder cancer in a large multi-institutional population. We found that we can accurately predict death after radical surgical treatment in patients treated with chemotherapy before surgery. We conclude that the pathological report provides key factors for determining survival probability.en_US
dc.language.isoenen_US
dc.publisherElsevier Scienceen_US
dc.relation.urlhttps://linkinghub.elsevier.com/retrieve/pii/S2405-4569(20)30208-Xen_US
dc.rightsCopyright © 2020. Published by Elsevier B.V.en_US
dc.subjectBladder canceren_US
dc.subjectEvaluationen_US
dc.subjectNomogramen_US
dc.subjectPredictionen_US
dc.subjectPrognosisen_US
dc.subjectRadical cystectomyen_US
dc.subjectRisken_US
dc.subjectWessex Classification Subject Headings::Urologyen_US
dc.titleNomogram Predicting Bladder Cancer-specific Mortality After Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle-invasive Bladder Cancer: Results of an International Consortiumen_US
dc.typeJournal Articleen_US
dc.identifier.journalEuropean Urology Focusen_US
dc.type.versionIn press (epub ahead of print)en_US
dc.description.admin-notepublished versionen_US


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