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Can We Go beyond Pathology? The Prognostic Role of Risk Scoring Tools for Cancer-Specific Survival of Patients with Bladder Cancer Undergoing Radical Cystectomy

Authors :
Aleksander Ślusarczyk
Rafał Wolański
Jerzy Miłow
Hanna Piekarczyk
Piotr Lipiński
Piotr Zapała
Grzegorz Niemczyk
Paweł Kurzyna
Andrzej Wróbel
Waldemar Różański
Piotr Radziszewski
Łukasz Zapała
Source :
Biomedicines, Vol 12, Iss 7, p 1541 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

Abstract

Radical cystectomy (RC) remains a mainstay surgical treatment for non-metastatic muscle-invasive and BCG-unresponsive bladder cancer. Various perioperative scoring tools assess comorbidity burden, complication risks, and cancer-specific mortality (CSM) risk. We investigated the prognostic value of these scores in patients who underwent RC between 2015 and 2021. Cox proportional hazards were used in survival analyses. Risk models’ accuracy was assessed with the concordance index (C-index) and area under the curve. Among 215 included RC patients, 63 (29.3%) died, including 53 (24.7%) cancer-specific deaths, with a median follow-up of 39 months. The AJCC system, COBRA score, and Charlson comorbidity index (CCI) predicted CSM with low accuracy (C-index: 0.66, 0.65; 0.59, respectively). Multivariable Cox regression identified the AJCC system and CCI > 5 as significant CSM predictors. Additional factors included the extent of lymph node dissection, histology, smoking, presence of concomitant CIS, and neutrophil-to-lymphocyte ratio, and model accuracy was high (C-index: 0.80). The internal validation of the model with bootstrap samples revealed its slight optimism of 0.06. In conclusion, the accuracy of the AJCC staging system in the prediction of CSM is low and can be improved with the inclusion of other pathological data, CCI, smoking history and inflammatory indices.

Details

Language :
English
ISSN :
22279059
Volume :
12
Issue :
7
Database :
Directory of Open Access Journals
Journal :
Biomedicines
Publication Type :
Academic Journal
Accession number :
edsdoj.2caa6c5fff2247babb9022e1b6d91f3e
Document Type :
article
Full Text :
https://doi.org/10.3390/biomedicines12071541