How cancer-specific mortality changes over time after radical cystectomy: Conditional survival of patients with nonmetastatic urothelial carcinoma of the urinary bladder

Carlotta Palumbo, Francesco A. Mistretta, Sophie Knipper, Angela Pecoraro, Zhe Tian, Shahrokh F. Shariat, Fred Saad, Claudio Simeone, Alberto Briganti, Alessandro Antonelli, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

Abstract

Objectives: 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. Methods and materials: 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. Results: 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.

Original languageEnglish
Pages (from-to)893-899
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Volume37
Issue number12
DOIs
Publication statusPublished - Dec 2019

Keywords

  • Cancer-specific mortality
  • Conditional survival
  • Nonmetastatic bladder cancer
  • Radical cystectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

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