Skip to main content

Advertisement

SpringerLink
Log in

A nomogram predicting the cancer-specific mortality in patients eligible for radical cystectomy evaluating clinical data and neoadjuvant cisplatinum-based chemotherapy

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Despite the increasing number of studies confirming the importance of neoadjuvant chemotherapy (NC) in patients before radical cystectomy (RC) for bladder cancer (BCa), NC remains underused. The aim of our study was to develop a nomogram predicting the cancer-specific mortality (CSM) of patients who underwent RC for transitional BCa, evaluating the available clinical information and the NC.

Materials and methods

We identified 423 patients who underwent RC and pelvic lymph node dissection, treated or not with NC, in two European high-volume centers between 2007 and 2013. Chi-square and Student’s t tests were used to evaluate differences between groups. Kaplan–Meier curves were used to assess time to cancer-specific (CSS) and overall survival (OS). Uni- (UVA) and multivariable (MVA) Cox regression analyses were developed to address predictors of CSS and OS. A nomogram based on the Cox regression coefficient was developed to show the impact of NC on CSM.

Results

Mean follow-up was 20.3 months. Our population had mainly pT2 disease (77.1 %), and 19.4 % had preoperative cisplatinum-based NC. NC showed better CSS at UVA (p = 0.014) and MVA (odds ratio: 0.44; p = 0.043). Overall, the 3-year OS and the CSS rate were 69.3 and 79 %, respectively. The nomogram developed to predict the 36-month CSM showed predictive accuracy of 67 %.

Conclusions

We developed the first nomogram predicting the 36-month CSM rate in patients with high-risk BCa according to the clinical data. Moreover, we demonstrate that preoperative cisplatinum-based chemotherapy is associated with better CSS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Chavan S, Bray F, Lortet-Tieulent J, Goodman M, Jemal A (2014) International variations in bladder cancer incidence and mortality. Eur Urol 66(1):59–73. doi:10.1016/j.eururo.2013.10.001

    Article  PubMed  Google Scholar 

  2. Witjes JA, Compérat E, Cowan NC et al (2014) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 65(4):778–792. doi:10.1016/j.eururo.2013.11.046

    Article  PubMed  Google Scholar 

  3. Meeks JJ, Bellmunt J, Bochner BH, Clarke NW, Daneshmand S, Galsky MD et al (2012) A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer. Eur Urol 62(3):523–533. doi:10.1016/j.eururo.2012.05.048

    Article  CAS  PubMed  Google Scholar 

  4. Sternberg CN, Bellmunt J, Sonpavde G, Siefker-Radtke AO, Stadler WM, Bajorin DF et al (2013) ICUD-EAU international consultation on bladder cancer 2012: chemotherapy for urothelial carcinoma-neoadjuvant and adjuvant settings. Eur Urol 63(1):58–66. doi:10.1016/j.eururo.2012.08.010

    Article  PubMed  Google Scholar 

  5. Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL et al (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349(9):859–866

    Article  CAS  PubMed  Google Scholar 

  6. Sherif A, Holmberg L, Rintala E, Mestad O, Nilsson J, Nilsson S, Malmstrom P-U (2004) Neoadjuvant cisplatinum based combination chemotherapy in patients with invasive bladder cancer: a combined analysis of two Nordic studies. Eur Urol 45(3):297–303

    Article  CAS  PubMed  Google Scholar 

  7. Griffiths G, Hall R, Sylvester R, Raghavan D, Parmar MKB (2011) International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol 29(16):2171–2177. doi:10.1200/JCO.2010.32.3139

    Article  CAS  PubMed  Google Scholar 

  8. Malmstrom PU, Rintala E, Wahlqvist R, Hellstrom P, Hellsten S, Hannisdal E (1996) Five-year followup of a prospective trial of radical cystectomy and neoadjuvant chemotherapy: nordic cystectomy trial I. The nordic cooperative bladder cancer study group. Juro 155(6):1903–1906

    CAS  Google Scholar 

  9. Niegisch G, Lorch A, Droller MJ, Lavery HJ, Stensland KD, Albers P (2013) Neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: which patients benefit? Eur Urol 64(3):355–357. doi:10.1016/j.eururo.2013.06.002

    Article  PubMed  Google Scholar 

  10. Witjes JA, Comperat E, Cowan NC, De Santis M, Gakis G, Lebret T et al (2014) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 65(4):778–792. doi:10.1016/j.eururo.2013.11.046

    Article  PubMed  Google Scholar 

  11. Roghmann F, Trinh Q-D, Braun K, von Bodman C, Brock M, Noldus J, Palisaar J (2014) Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol: Official Journal of the Japanese Urological Association 21(2):143–149. doi:10.1111/iju.12232

    Article  Google Scholar 

  12. Porter MP, Kerrigan MC, Donato BMK, Ramsey SD (2011) Patterns of use of systemic chemotherapy for Medicare beneficiaries with urothelial bladder cancer. Uro 29(3):252–258. doi:10.1016/j.urolonc.2009.03.021

    Google Scholar 

  13. Rehman S, Crane A, Din R, Raza SJ, Shi Y, Wilding G et al (2013) Understanding avoidance, refusal, and abandonment of chemotherapy before and after cystectomy for bladder cancer. Urology 82(6):1370–1375. doi:10.1016/j.urology.2013.07.055

    Article  PubMed  Google Scholar 

  14. Thompson RH, Boorjian SA, Kim SP, Cheville JC, Thapa P, Tarrel R et al (2014) Eligibility for neoadjuvant/adjuvant cisplatin-based chemotherapy among radical cystectomy patients. BJU Int 113(5b):E17–E21. doi:10.1111/bju.12274

    Article  CAS  PubMed  Google Scholar 

  15. Gandaglia G, Popa I, Abdollah F, Schiffmann J, Shariat SF, Briganti A et al (2014) The effect of neoadjuvant chemotherapy on perioperative outcomes in patients who have bladder cancer treated with radical cystectomy: a Population-based study. Eur Urol 66(3):561–568. doi:10.1016/j.eururo.2014.01.014

    Article  CAS  PubMed  Google Scholar 

  16. Karakiewicz PI, Shariat SF, Palapattu GS, Gilad AE, Lotan Y, Rogers CG et al (2006) Nomogram for predicting disease recurrence after radical cystectomy for transitional cell carcinoma of the bladder. J Urol 176(4 Pt 1):1354–1361. doi:10.1016/j.juro.2006.06.025 (discussion 1361-2)

    Article  PubMed  Google Scholar 

  17. Al-Daghmin A, English S, Kauffman EC, Din R, Khan A, Syed JR et al (2014) External validation of preoperative and postoperative nomograms for prediction of cancer-specific survival, overall survival and recurrence after robot-assisted radical cystectomy for urothelial carcinoma of the bladder. BJU Int 114(2):253–260. doi:10.1111/bju.12484

    Article  PubMed  Google Scholar 

  18. Lughezzani G, Sun M, Shariat SF, Budäus L, Thuret R, Jeldres C et al (2011) A population-based competing-risks analysis of the survival of patients treated with radical cystectomy for bladder cancer. Cancer 117(1):103–109. doi:10.1002/cncr.25345

    Article  PubMed  Google Scholar 

  19. Shariat SF, Margulis V, Lotan Y, Montorsi F, Karakiewicz PI (2008) Nomograms for bladder cancer. Eur Urol 54(1):41–53. doi:10.1016/j.eururo.2008.01.004

    Article  PubMed  Google Scholar 

  20. Djaladat H, Bruins HM, Miranda G, Cai J, Skinner EC, Daneshmand S (2014) The association of preoperative serum albumin level and American society of anesthesiologists (ASA) score on early complications and survival of patients undergoing radical cystectomy for urothelial bladder cancer. BJU Int 113(6):887–893. doi:10.1111/bju.12240

    Article  CAS  PubMed  Google Scholar 

  21. Zargar H, Espiritu PN, Fairey AS, Mertens LS, Dinney CP, Mir MC et al (2014) Multicenter assessment of neoadjuvant chemotherapy for muscle-invasive bladder cancer. Eur Urol. doi:10.1016/j.eururo.2014.09.007

    Google Scholar 

  22. Reardon ZD, Patel SG, Zaid HB, Stimson CJ, Resnick MJ, Keegan KA et al (2015) Trends in the use of perioperative chemotherapy for localized and locally advanced muscle-invasive bladder cancer: a sign of changing tides. Eur Urol 67(1):165–170. doi:10.1016/j.eururo.2014.01.009 (Epub 2014 Jan 23)

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Author’s contribution

Project development: Di Trapani, Sanchez-Salas, Suardi, Briganti. Data collection: Rocchini, Di Trapani, Moschini, Carneiro, Lizee. Data analysis: Di Trapani, Gandaglia. Manuscript writing: Di Trapani. Manuscript editing: Sanchez- Salas, Cathelineau, Montorsi, Barret, Rozet, Galiano, Bennamoun, Colombo, Sivaraman, Briganti.

Author information

Authors and Affiliations

  1. Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy

    Ettore Di Trapani, Giorgio Gandaglia, Lorenzo Rocchini, Marco Moschini, Renzo Colombo, Nazareno Suardi, Alberto Briganti & Francesco Montorsi

  2. Department of Urology, L’Institut Mutualiste Montsouris, Paris, France

    Ettore Di Trapani, Rafael Sanchez-Salas, Daphne Lizee, Arie Carneiro, Arjun Sivaraman, Eric Barret, François Rozet, Marc Galiano & Xavier Cathelineau

  3. Department of Medical Oncology, L’Institut Mutualiste Montsouris, Paris, France

    Mostefa Bennamoun

Authors
  1. Ettore Di Trapani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rafael Sanchez-Salas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giorgio Gandaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lorenzo Rocchini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marco Moschini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daphne Lizee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Arie Carneiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Arjun Sivaraman
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eric Barret
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. François Rozet
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Marc Galiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mostefa Bennamoun
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Renzo Colombo
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Nazareno Suardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Alberto Briganti
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Francesco Montorsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Xavier Cathelineau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rafael Sanchez-Salas.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Trapani, E., Sanchez-Salas, R., Gandaglia, G. et al. A nomogram predicting the cancer-specific mortality in patients eligible for radical cystectomy evaluating clinical data and neoadjuvant cisplatinum-based chemotherapy. World J Urol 34, 207–213 (2016). https://doi.org/10.1007/s00345-015-1640-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-015-1640-2

Keywords

Search

Navigation