Palumbo Carlotta, Mistretta Francesco A, Knipper Sophie, Pecoraro Angela, Tian Zhe, Shariat Shahrokh F, Saad Fred, Simeone Claudio, Briganti Alberto, Antonelli Alessandro, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, Milan, Italy.
Urol Oncol. 2019 Dec;37(12):893-899. doi: 10.1016/j.urolonc.2019.05.020. Epub 2019 Jul 8.
We studied the effect of conditional survival on 5-year cancer-specific mortality (CSM) probability in a contemporary North-American population-based nonmetastatic urothelial carcinoma of urinary bladder cohort treated with radical cystectomy.
Within the SEER database (2004-2015), we identified pTa/pTis/pT1N0 high grade, pT2 to pT4N0 and pTanyN1-3 patients treated with radical cystectomy for nonmetastatic urothelial carcinoma of urinary bladder. Conditional 5-year CSM-free estimates were assessed after event-free follow-up duration. Multivariable Cox regression models predicted CSM according to event-free follow-up duration.
According to T and N stages, 1,079 (7.9%) pTa/pTis/pT1N0, 5,058 (37.2%) pT2N0, 2,865 (21.1%) pT3N0, 1,211 pT4N0 (8.9%) and 3,382 (24.9%) pTanyN1-3 patients were included. Conditional CSM-free estimates increased from 90.1 to 91.8%, 80.6 to 92.5%, 62.5 to 90.7%, 53.1 to 84.5%, and 37.5 to 84.0% after 5 years of event-free follow-up, in respectively pTa/pTis/pT1N0, pT2N0, pT3N0, pT4N0, and pTanyN1-3 patients. Attrition due to mortality was highest in pTanyN1-3 cohort and lowest in pTa/pTis/pT1N0. In Multivariable Cox regression analyses, pT2N0 (hazard ratio [HR] 1.9 P< 0.001), pT3N0 (HR 4.3 P< 0.001), pT4N0 (HR 5.8 P< 0.001) and pTanyN1-3 (HR 9.1 P< 0.001) were independent predictors of higher CSM at baseline, relative to pTa/pTis/pT1N0. A decrease in all conditional HRs to nonsignificant levels was recorded at 60 months for pT4N0 and pTanyN1-3 and at 48 months for pT2N0 and pT3N0. CONCLUSIONS CONDITIONAL SURVIVAL: showed a direct relationship between event-free follow-up duration and survival probability. Conditional CSM-free estimates increased in proportion with event-free follow-up but also resulted in equally proportional increase in attrition rates.
我们研究了在当代北美以人群为基础的接受根治性膀胱切除术治疗的非转移性膀胱尿路上皮癌队列中，条件生存对5年癌症特异性死亡率（CSM）概率的影响。
在监测、流行病学和最终结果（SEER）数据库（2004 - 2015年）中，我们识别出接受根治性膀胱切除术治疗非转移性膀胱尿路上皮癌的pTa/pTis/pT1N0高分级、pT2至pT4N0以及pTanyN1 - 3患者。在无事件随访期后评估5年无CSM的条件估计值。多变量Cox回归模型根据无事件随访期预测CSM。
根据T和N分期，纳入了1079例（7.9%）pTa/pTis/pT1N0、5058例（37.2%）pT2N0、2865例（21.1%）pT3N0、1211例pT4N0（8.9%）和3382例（24.9%）pTanyN1 - 3患者。在分别对pTa/pTis/pT1N0、pT2N0、pT3N0、pT4N0和pTanyN1 - 3患者进行5年无事件随访后，无CSM的条件估计值分别从90.1%增至91.8%、80.6%增至92.5%、62.5%增至90.7%、53.1%增至84.5%以及37.5%增至84.0%。因死亡导致的失访在pTanyN1 - 3队列中最高，在pTa/pTis/pT1N0队列中最低。在多变量Cox回归分析中，相对于pTa/pTis/pT1N0，pT2N0（风险比[HR] 1.9，P < 0.001）、pT3N0（HR 4.3，P < 0.001）、pT4N0（HR 5.8，P < 0.001）和pTanyN1 - 3（HR 9.1，P < 0.001）在基线时是较高CSM的独立预测因素。对于pT4N0和pTanyN1 - 3，在60个月时所有条件HR降至非显著水平；对于pT2N0和pT3N0，在48个月时降至非显著水平。结论 条件生存：显示了无事件随访期与生存概率之间的直接关系。无CSM的条件估计值随无事件随访期成比例增加，但也导致失访率同样成比例增加。
