Prognostic risk stratification of patients with urothelial carcinoma of the bladder with recurrence after radical cystectomy

J Urol. 2013 Apr;189(4):1275-81. doi: 10.1016/j.juro.2012.10.065. Epub 2012 Oct 30.


Purpose: We identify clinicopathological variables predicting overall survival in patients with recurrent bladder urothelial carcinoma after radical cystectomy.

Materials and methods: We retrospectively collected data on 114 patients treated with radical cystectomy for bladder urothelial carcinoma who subsequently had remote metastasis and/or local recurrence. The Kaplan-Meier method with the log rank test and multivariate Cox regression models were used to address overall survival after recurrence.

Results: During followup 99 of the 114 patients died. Median survival in the 114 patients was 11.2 months. One and 3-year overall survival rates were 48.0% and 12.1%, respectively. On multivariate analysis independent predictors of poorer overall survival included less than 1 year to recurrence, symptoms at recurrence, 2 or more metastatic organs at recurrence, high serum C-reactive protein, high lactate dehydrogenase, no post-recurrence platinum based chemotherapy and no metastasectomy. Based on the 4 variables (time to recurrence, symptoms, number of metastatic organs and C-reactive protein), we constructed a risk model predicting post-recurrence overall survival that classified patients into 3 groups with significantly different overall survival (p <0.0001).

Conclusions: Our data confirm that recurrent urothelial carcinoma after radical cystectomy is a highly aggressive, lethal disease. Seven clinicopathological factors were identified that predicted post-recurrence overall survival. Our risk model based on the 4 variables could be useful to provide relevant prognostic information to patients and physicians, and better stratify patients in clinical trials.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Transitional Cell / epidemiology*
  • Carcinoma, Transitional Cell / surgery*
  • Cystectomy* / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology*
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Urinary Bladder Neoplasms / epidemiology*
  • Urinary Bladder Neoplasms / surgery*