Introduction and Objectives
Radical cystectomy has emerged as the primary treatment for localized or locally advanced invasive and high-risk superficial bladder cancer. In about half of patients undergoing surgery will develope distant metastasis. The key point of the adequate follow-up is the progression risk evaluation. The aim of the study is the validation of the MSKCC postoperative nomogram predicting 5-year progressionfree probability after cystectomy. The monogram includes informations on patient sex, age, time from diagnosis to surgery, histology, node status and tumor grade.
Material and Methods
We performed radical cystectomy for cancer in 102 subjects from January 2002 to June 2008. Using the MSKCC nomogram we retrospectively evaluated their postoperative status. Three groups of progression risk were determined – high (calculated probability of remaining disease free at 5 years after cystectomy of 0–39%), intermediate (40–69%) and low (70–100%). We compared the monogram informations to the real metastasis and local reccurence development in our patients.
In our file were 77 men and 25 women, the mean age was 65 years (46–77), transitional cell carcinoma was represented in 95% (n = 97), sqaumous cell carcinoma in 3% (n = 3), adenocarcinoma in 1% (n = 1) and small cell carcinoma in 1% (n = 1). The tumor stage of Tis in 4% (n = 4), Ta in 2% (n = 2), T1 in 22% (n = 22), T2 in 26% (n = 27), T3 in 24% (n = 24), T4 in 21% (n = 21) was reported. The tumor stage of T0 was described in 2 patients. The concomitant Tis was found in 6 cases. The high grade tumors were reported in 79% (n = 81), low grade tumors in 21% (n = 21), the positive nodes in 16% (n = 16). The synchronous development of prostate cancer was found in 18% of men (n = 14), possibly significant tumor of GS≥7 in 2 cases. The median 5-year progression-free probability of 10% (range 1–25%) was calculated in the high risk group (enrolled 21% of patients, n = 21), 61% (range 43–66%) in the intermediate risk group (enrolled 35% of subjects, n = 36) and 83% (70–96%) in the low risk group (44% of patients, n = 45). The median follow-up for the entire cohort was 35 months (2–90). The distant metastasis or local reccurance were detected in 27% (n = 12) in the low risk arm (17% expected according to the MSKCC nomogram), in 42% (n = 15) in the intermediate group (39% expected) and in 76% (n = 16) in the high risk arm (90% expected) during follow-up.
Although the statistically significant difference in results of the group of the low risk (27% versus 17%) and high risk (76% versus 90%) of disease reccurance was found, the MSKCC nomogram has high predictive value in calculation of the progression-free probability in patients after radical cystectomy.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.