Introduction
Asymptomatic recurrence and oncological outcomes
MIBC
Authors (year) | No. of patients | No. of patients with recurrence (%) | Symptomatic versus asymptomatic (%) | Prognostic risk of symptomatic recurrence | Analysis |
---|---|---|---|---|---|
Bladder cancer | |||||
Volkmer et al. (2009) | 1,270 | 444 (49%) | 65% versus 35% | No (not significant in OS) | Univariate, log rank test |
Giannarini et al. (2010) | 479 | 174 (36%) | 50% versus 50% | Yes (HR 1.51, P = 0.015 in OS) | Multivariate Cox regression analysis |
Boorjian et al. (2011) | 1,599 | 606 (38%) | 77% versus 23% | Yes (HR 1.59, P = 0.0001 in OS) | Multivariate Cox regression analysis |
Nieuwenhuijzen et al. (2013) | 343 | 158 (46%) | 64% versus 36% | Yes (HR 2.40, P = 0.013 in CSS) | Multivariate Cox regression analysis |
Alimi et al. (2016) | 331 | 160 (49%) | 81% versus 19% | Yes (HR 1.81, P = 0.040 in CSS) | Multivariate Cox regression analysis |
Kusaka et al. (2017) | 581 | 175 (30%) | 53% versus 47% | Yes (HR 1.94, P < 0.001 in OS) | IPTW-adjusted multivariate Cox regression analysis |
Osterman et al. (2017) | 463 | 197 (43%) | 54% versus 36% | Yes (HR 1.74, P < 0.05 in OS) | Multivariate Cox regression analysis |
UTUC | |||||
Horiguchi et al. (2017) | 415 | 108 (26%) | 43% versus 57% | Yes (HR 2.08, P = 0.009 in OS) | IPTW-adjusted multivariate Cox regression analysis |
UTUC
Impact of lead-time bias on outcomes
Risk factors for symptomatic recurrence
Risk factor | P value | HR | 95% CI | |
---|---|---|---|---|
MIBC | ||||
Age | Continuous | 0.247 | 1.01 | 0.99–1.04 |
Sex | Male | 0.193 | 0.73 | 0.45–1.17 |
CVD | Positive | 0.880 | 1.04 | 0.62–1.76 |
DM | Positive | 0.595 | 1.19 | 0.63–2.26 |
Preoperative eGFR | Continuous | 0.765 | 1.00 | 0.99–1.01 |
NAC | Underwent | 0.025 | 1.64 | 1.06–2.53 |
Urinary diversion | Ileal neobladder | 0.483 | 0.86 | 0.56–1.31 |
Pathological risk | pT3–4, LVI, or pN+ | 0.029 | 1.67 | 1.05–2.64 |
UTUC | ||||
Age | Continuous | 0.838 | 1.00 | 0.96–1.03 |
Sex | Male | 0.645 | 0.87 | 0.48–1.58 |
CVD | Positive | 0.138 | 1.76 | 0.83–3.70 |
DM | Positive | 0.734 | 1.18 | 0.45–3.08 |
Preoperative eGFR | Continuous | 0.857 | 1.00 | 0.97–1.02 |
NAC | Underwent | 0.031 | 2.08 | 1.07–4.04 |
Pathological risk | pT3–4, LVI, or pN+ | 0.001 | 1.37 | 1.14–1.65 |
Cost-effectiveness in regular follow-up after surgery
Variable | Status | Risk-score |
---|---|---|
Cardiovascular disease | Positive | 1 |
Preoperative CKD | Positive | 1 |
Urinary diversion | Non-neobladder | 1 |
Pathological T stage | ≥ pT3 or SM+ | 1 |
Pathological N stage | pN positive | 1 |
Lymphovascular invasion | Positive | 1 |
Risk-score-based classification | Sum of risk-score |
---|---|
Low-risk | 0−1 |
Intermediate-risk | 2−3 |
High-risk | 4−6 |
Variable | Status | Risk-score |
---|---|---|
Tumor in ureter | Positive | 1 |
Hydronephrosis | Positive | 1 |
Lymph node involvement (cN+ or pN+) | Positive | 2 |
Preoperative CKD | Positive | 2 |
Pathological T stage | pT3–4 | 2 |
Lymphovascular invasion | Positive | 2 |
Surgical margin | Positive | 2 |
Risk-score-based classification | Sum of risk-score |
---|---|
Low-risk | 0−2 |
Intermediate-risk | 3−5 |
High-risk | 6−12 |