Objective: To identify prognostic clinical and histopathological parameters, including comorbidity indices at the time of radical cystectomy (RC), for overall survival (OS) after recurrence following RC for urothelial carcinoma of the bladder (UCB). Materials and Methods: A retrospective multicenter study was carried out in 555 unselected consecutive patients who underwent RC with pelvic lymph node dissection for UCB from 2000 to 2010. A total of 227 patients with recurrence comprised our study group. Cox proportional hazards regression models were calculated with established variables to assess their independent influence on OS after recurrence. Results: The median time from RC to recurrence and the median OS after recurrence was 10.9 and 5.4 months, respectively. Neither the time to recurrence nor the type of recurrence (systematic vs. local) was predictive of the OS. In contrast, age (hazard ratio (HR) 1.53, p = 0.011), lymph node metastasis (HR 1.56, p = 0.007), and positive surgical margins (HR 1.53, p = 0.046) significantly affected the OS after disease recurrence. In addition, the dichotomized Charlson comorbidity index (CCI; dichotomized into >2 vs. 0-2) was the only comorbidity score with an independent prediction of OS (HR 1.41, p = 0.033). We observed a significant gain in the base model's predictive accuracy, i.e. from 68.4 to 70.3% (p < 0.001), after inclusion of the dichotomized CCI. Conclusions: We present the first outcome study of comorbidity indices used as predictors of OS after disease recurrence in patients undergoing RC for UCB. The CCI at the time of RC had no significant influence on the time to recurrence but represented an independent predictor of OS after disease recurrence.

Keywords:
Bladder cancer, Distant recurrence, Local recurrence, Time to recurrence, Outcome, Transitional cell carcinoma, Comorbidity scores
1.
Stein JP, Lieskovsky G, Cote R, et al: Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001;19:666-675.
2.
Madersbacher S, Hochreiter W, Burkhard F, et al: Radical cystectomy for bladder cancer today - a homogeneous series without neoadjuvant therapy. J Clin Oncol 2003;21:690-696.
3.
Shariat SF, Karakiewicz PI, Palapattu GS, et al: Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol 2006;176:2414-2422.
4.
Rink M, Lee DJ, Kent M, et al: Predictors of cancer-specific mortality after disease recurrence following radical cystectomy. BJU Int 2013;111:E30-E36.
5.
Nakagawa T, Hara T, Kawahara T, et al: Prognostic risk stratification of patients with urothelial carcinoma of the bladder with recurrence after radical cystectomy. J Urol 2013;189:1275-1281.
6.
Mitra AP, Quinn DI, Dorff TB, et al: Factors influencing post-recurrence survival in bladder cancer following radical cystectomy. BJU Int 2012;109:846-854.
7.
Boorjian SA, Tollefson MK, Cheville JC, Costello BA, Thapa P, Frank I: Detection of asymptomatic recurrence during routine oncological followup after radical cystectomy is associated with improved patient survival. J Urol 2011;186:1796-1802.
8.
Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr: Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004;291:2441-2447.
9.
Mayr R, May M, Martini T, et al: Predictive capacity of four comorbidity indices estimating perioperative mortality after radical cystectomy for urothelial carcinoma of the bladder. BJU Int 2012;110:E222-E227.
10.
Mayr R, May M, Martini T, et al: Comorbidity and performance indices as predictors of cancer-independent mortality but not of cancer-specific mortality after radical cystectomy for urothelial carcinoma of the bladder. Eur Urol 2012;62:662-670.
11.
Sobin LH, Gospodarowicz MK, Wittekind C: International Union against Cancer TNM Classification of Malignant Tumours. Oxford, Wiley-Blackwell, 2010.
12.
Bolenz C, Ho R, Nuss GR, et al: Management of elderly patients with urothelial carcinoma of the bladder: guideline concordance and predictors of overall survival. BJU Int 2010;106:1324-1329.
13.
Novotny V, Hakenberg OW, Froehner M, et al: Systematic assessment of complications and outcome of radical cystectomy undertaken with curative intent in patients with comorbidity and over 75 years of age. Urol Int 2013;90:195-201.
14.
Harrell FE Jr, Lee KL, Mark DB: Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996;15:361-387.
15.
Lachin JM: Power of the Mantel-Haenszel and other tests for discrete or grouped time-to-event data under a chained binomial model. Stat Med 2013;32:220-229.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.