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Oncologic surveillance following radical cystectomy: an individualized risk-based approach

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Abstract

Purpose

To provide an alternative surveillance approach for bladder cancer (BC) following radical cystectomy (RC) according to more accurate predictions of a patient’s projected BC course.

Methods

We identified 1797 patients who underwent RC for M0 BC between 1980 and 2007. Patients were stratified by pathologic stage (pT0Nx-0, pTa/CIS/1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN+), relapse location (urethra, upper tract, abdomen/pelvis, chest, and other), age (≤60, 61–70, 71–80, >80 years) and Charlson Co-morbidity Index (CCI ≤2 and CCI ≥3). Risks of disease recurrence and non-BC death were modeled using Weibull distributions. Recommended surveillance durations were estimated when the risk of non-BC death exceeded the risk of recurrence.

Results

At a median follow-up of 10.6 years (IQR 6.8,15.2), 713 patients developed recurrence. Vastly different recurrence patterns were appreciated. Specifically, among patients ≤60 years with pT2Nx-0, non-BC death risk exceeded the risk of recurrence in the abdomen at 7.5 years following surgery when CCI was ≥3, versus at year 10 after RC when CCI was ≤2. Meanwhile, for patients >80 years with pT2Nx-0, non-BC death risk exceeded the risk of abdominal recurrence at 1 year after RC, regardless of CCI.

Conclusion

We present an alternative post-RC surveillance approach that incorporates a patient’s changing risk profile with the influence of competing health factors. We believe this strategy provides more individualized recommendations than current guidelines, and may improve the benefit derived from surveillance while reducing resource misappropriation.

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References

  1. Stewart-Merrill SB, Boorjian SA, Thompson RH, Psutka SP, Cheville JC, Thapa P, Bergstrahl EJ, Tollefson MK, Frank I (2015) Evaluation of current surveillance guidelines following radical cystectomy and proposal of a novel risk-based approach. Urol Oncol 33(8):339-e1–339-e8. doi:10.1016/j.urolonc.2015.04.017

    Article  Google Scholar 

  2. NCCN Clinical practice guidelines in oncology: bladder cancer (2013). http://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf. Accessed 6 Jan 2014

  3. European Association of Urology: guidelines on muscle-invasive and metastatic bladder cancer (2013). http://www.uroweb.org/guidelines/online-guidelines/. Accessed 6 Jan 2014

  4. Giannarini G, Kessler TM, Thoeny HC, Nguyen DP, Meissner C, Studer UE (2010) Do patients benefit from routine follow-up to detect recurrences after radical cystectomy and ileal orthotopic bladder substitution? Eur Urol 58(4):486–494. doi:10.1016/j.eururo.2010.05.041

    Article  PubMed  Google Scholar 

  5. Kuroda M, Meguro N, Maeda O, Saiki S, Kinouchi T, Usami M, Kotake T (2002) Stage specific follow-up strategy after cystectomy for carcinoma of the bladder. Int J Urol 9(3):129–133

    Article  PubMed  Google Scholar 

  6. Slaton JW, Swanson DA, Grossman HB, Dinney CP (1999) A stage specific approach to tumor surveillance after radical cystectomy for transitional cell carcinoma of the bladder. J Urol 162(3 Pt 1):710–714

    Article  CAS  PubMed  Google Scholar 

  7. Vrooman OP, Witjes JA (2010) Follow-up of patients after curative bladder cancer treatment: guidelines vs. practice. Curr Opin Urol 20(5):437–442. doi:10.1097/MOU.0b013e32833cf10e

    Article  PubMed  Google Scholar 

  8. Yafi FA, Aprikian AG, Fradet Y, Chin JL, Izawa J, Rendon R, Estey E, Fairey A, Cagiannos I, Lacombe L, Lattouf JB, Bell D, Saad F, Drachenberg D, Kassouf W (2012) Surveillance guidelines based on recurrence patterns after radical cystectomy for bladder cancer: the Canadian Bladder Cancer Network experience. BJU Int 110(9):1317–1323. doi:10.1111/j.1464-410X.2012.11133.x

    Article  PubMed  Google Scholar 

  9. Svatek RS, Hollenbeck BK, Holmang S, Lee R, Kim SP, Stenzl A, Lotan Y (2014) The economics of bladder cancer: costs and considerations of caring for this disease. Eur Urol 66(2):253–262. doi:10.1016/j.eururo.2014.01.006

    Article  PubMed  Google Scholar 

  10. Avritscher EB, Cooksley CD, Grossman HB, Sabichi AL, Hamblin L, Dinney CP, Elting LS (2006) Clinical model of lifetime cost of treating bladder cancer and associated complications. Urology 68(3):549–553. doi:10.1016/j.urology.2006.03.062

    Article  PubMed  Google Scholar 

  11. Carroll KJ (2003) On the use and utility of the Weibull model in the analysis of survival data. Control Clin Trials 24(6):682–701

    Article  PubMed  Google Scholar 

  12. Suardi N, Porter CR, Reuther AM, Walz J, Kodama K, Gibbons RP, Correa R, Montorsi F, Graefen M, Huland H, Klein EA, Karakiewicz PI (2008) A nomogram predicting long-term biochemical recurrence after radical prostatectomy. Cancer 112(6):1254–1263. doi:10.1002/cncr.23293

    Article  PubMed  Google Scholar 

  13. Merrill RM, Hunter BD (2010) Conditional survival among cancer patients in the United States. Oncologist 15(8):873–882. doi:10.1634/theoncologist.2009-0211

    Article  PubMed  PubMed Central  Google Scholar 

  14. Skuladottir H, Olsen JH (2003) Conditional survival of patients with the four major histologic subgroups of lung cancer in Denmark. J Clin Oncol 21(16):3035–3040. doi:10.1200/JCO.2003.04.521

    Article  PubMed  Google Scholar 

  15. Abdollah F, Suardi N, Capitanio U, Matloob R, Fossati N, Castiglione F, Di Trapani E, Di Trapani D, Russo A, Carenzi C, Montorsi F, Rigatti P, Bertini R (2014) The key role of time in predicting progression-free survival in patients with renal cell carcinoma treated with partial or radical nephrectomy: conditional survival analysis. Urol Oncol 32(1):43-e9–43-e16. doi:10.1016/j.urolonc.2013.05.006

    Article  Google Scholar 

  16. Ploussard G, Shariat SF, Dragomir A, Kluth LA, Xylinas E, Masson-Lecomte A, Rieken M, Rink M, Matsumoto K, Kikuchi E, Klatte T, Boorjian SA, Lotan Y, Roghmann F, Fairey AS, Fradet Y, Black PC, Rendon R, Izawa J, Kassouf W (2014) Conditional survival after radical cystectomy for bladder cancer: evidence for a patient changing risk profile over time. Eur Urol 66(2):361–370. doi:10.1016/j.eururo.2013.09.050

    Article  PubMed  Google Scholar 

  17. Boorjian SA, Kim SP, Tollefson MK, Carrasco A, Cheville JC, Thompson RH, Thapa P, Frank I (2013) Comparative performance of comorbidity indices for estimating perioperative and 5-year all cause mortality following radical cystectomy for bladder cancer. J Urol 190(1):55–60. doi:10.1016/j.juro.2013.01.010

    Article  PubMed  Google Scholar 

  18. Shariat SF, Karakiewicz PI, Palapattu GS, Lotan Y, Rogers CG, Amiel GE, Vazina A, Gupta A, Bastian PJ, Sagalowsky AI, Schoenberg MP, Lerner SP (2006) Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol 176(6 Pt 1):2414–2422. doi:10.1016/j.juro.2006.08.004 (discussion 2422)

    Article  PubMed  Google Scholar 

  19. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, Raghavan D, Skinner DG (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19(3):666–675

    Article  CAS  PubMed  Google Scholar 

  20. Boorjian SA, Tollefson MK, Cheville JC, Costello BA, Thapa P, Frank I (2011) Detection of asymptomatic recurrence during routine oncological followup after radical cystectomy is associated with improved patient survival. J Urol 186(5):1796–1802. doi:10.1016/j.juro.2011.07.005

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Suzanne B. Merrill

  2. Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Stephen A. Boorjian, R. Houston Thompson, Matthew K. Tollefson & Igor Frank

  3. Division of Urology, Hospital of Cook County, Chicago, IL, USA

    Sarah P. Psutka

  4. Department of Pathology, Mayo Clinic, Rochester, MN, USA

    John C. Cheville

  5. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Prabin Thapa

Authors
  1. Suzanne B. Merrill
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  2. Stephen A. Boorjian
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  3. R. Houston Thompson
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  4. Sarah P. Psutka
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  5. John C. Cheville
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  6. Prabin Thapa
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  7. Matthew K. Tollefson
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  8. Igor Frank
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Contributions

SB Merrill: Project development, data analysis, manuscript writing/editing. SA Boorjian: Data collection, data analysis, manuscript editing. RH Thompson: Data collection, manuscript editing. SP Psutka: Data analysis, manuscript editing. J Cheville: Data collection/management. P Thapa: Data collection/management, data analysis. M Tollefoson: Data collection, manuscript editing. I Frank: Project development, data collection, data analysis, manuscript editing

Corresponding author

Correspondence to Igor Frank.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Merrill, S.B., Boorjian, S.A., Thompson, R.H. et al. Oncologic surveillance following radical cystectomy: an individualized risk-based approach. World J Urol 35, 1863–1869 (2017). https://doi.org/10.1007/s00345-017-2068-7

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  • DOI: https://doi.org/10.1007/s00345-017-2068-7

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