Novel prognostic model proposed for disease-specific survival in bladder cancer patients
A novel prognostic stratification model based on risk factors has been developed for disease-specific survival (DSS) in bladder cancer patients who have been treated with radical cystectomy. The model was developed by investigating prognostic indicators that included clinical-pathological and preoperative factors. Two types of preoperative hematological disorders that are assessed by hemoglobin and C-reactive protein (CRP) were found to be independent prognostic indications for patients with bladder cancer who were treated with radical cystectomy.
"Despite the wealth of evidence on the oncological significance of various clinico-pathological and molecular parameters for survival in invasive bladder cancer patients treated with radical cystectomy, alterations of preoperative hematological parameters have not been sufficiently addressed," wrote the authors of the study, which was presented at the 28th European Association of Urology Congress, held March 15-19, 2013, in Milan, Italy.
"The findings suggest that preoperative hemoglobin and CRP levels, which can be easily obtained during routine practice, provide additional independent prognostic information for DSS. Moreover, our risk stratification model, which combines both hematological and pathological parameters, may provide physicians with useful prognostic information for identifying patients who may be candidates for multimodal treatment, including innovative adjuvant treatments."
In the course of the study, the researchers performed a retrospective analysis of 249 consecutive bladder cancer patients treated with radical cystectomy without neoadjuvant therapy at several institutions.
The prognostic value of the preoperative hematological laboratory parameters and the patients' clinical-pathological parameters were evaluated by univariate and multivariate Cox proportional hazard model analyses. Based on these data, the scientists developed a new scoring model to predict DSS after radical cystectomy using the regression coefficients of the multivariate model.
The DSS rates were 89% at 1 year, 69% at 3 years, and 63% at 5 years. Multivariate analysis found that preoperative values of low hemoglobin (< 10 g/dL) and high CRP (>0.5 mg/dL), pathological T stage (≥pT3a), lympho-vascular invasion (LVI), and positive surgical margin (PSM) status were independent factors for predicting poor prognosis. The score was calculated as 2 (if PSM) + 2 (Hb <10 g/dL) + 1 (if ≥ pT3a) + 1 (if LVI) + 1 (CRP >0.5 mg/dL) and 0 (if otherwise).
The 4-year DSS was 83% for patients with a score of 0-1 (low risk), 49% for those with a score of 2-3 (intermediate risk), and 6% for those with a score of 4-7 (high risk). All differences in DSS between subgroups were significant (P <.0001).