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Cancer and all-cause mortality in bladder cancer patients undergoing radical cystectomy: Development and validation of a nomogram for treatment decision-making

Urology Aug 31, 2017

Williams SB, et al. – Aim of this study was to establish and validate a nomogram assessing cancer and all–cause mortality following radical cystectomy. The results of this study indicated that older, unmarried patients with increased comorbidities are less likely to undergo radical cystectomy. They established and validated a generalizable instrument which has been converted into an on–line tool, to provide a benefit–risk assessment for patients considering radical cystectomy.

Methods
  • Between January 1, 2006 to December 31, 2011, a sum of 5,325 and 1,257 diagnosed with clinical stage T2–T4a muscle–invasive bladder cancer from Surveillance, Epidemiology, and End Results (SEER)–Medicare and Texas Cancer Registry (TCR)–Medicare linked–data, respectively.
  • They applied cox proportional hazards models and a established anomogram to predict 3– and 5–year overall and cancer–specific survival with external validation.

Results
  • It was noted that patients who underwent radical cystectomy were more likely to have been younger, male, married, non–Hispanic white and to have had fewer comorbidities than those who did not undergo radical cystectomy (p<0.001).
  • The data showed that married patients, in comparison to their unmarried counterparts, had both improved overall (Hazard Ratio (HR) 0.76= 95% CI 0.70 to 0.83, p<0.001) and cancer–specific (HR 0.76= 95% CI 0.68 to 0.85, p<0.001) survival.
  • A nomogram established applying SEER–Medicare data, predicted 3– and 5–year overall and cancer–specific survival rates with concordance indices of 0.65 and 0.66 in the validated TCR–Medicare cohort, respectively.
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