Oncologic surveillance following radical cystectomy: an individualized risk-based approach

Suzanne Merrill, Stephen A. Boorjian, R. Houston Thompson, Sarah P. Psutka, John C. Cheville, Prabin Thapa, Matthew K. Tollefson, Igor Frank

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To provide an alternative surveillance approach for bladder cancer (BC) following radical cystectomy (RC) according to more accurate predictions of a patient’s projected BC course. Methods: We identified 1797 patients who underwent RC for M0 BC between 1980 and 2007. Patients were stratified by pathologic stage (pT0Nx-0, pTa/CIS/1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN+), relapse location (urethra, upper tract, abdomen/pelvis, chest, and other), age (≤60, 61–70, 71–80, >80 years) and Charlson Co-morbidity Index (CCI ≤2 and CCI ≥3). Risks of disease recurrence and non-BC death were modeled using Weibull distributions. Recommended surveillance durations were estimated when the risk of non-BC death exceeded the risk of recurrence. Results: At a median follow-up of 10.6 years (IQR 6.8,15.2), 713 patients developed recurrence. Vastly different recurrence patterns were appreciated. Specifically, among patients ≤60 years with pT2Nx-0, non-BC death risk exceeded the risk of recurrence in the abdomen at 7.5 years following surgery when CCI was ≥3, versus at year 10 after RC when CCI was ≤2. Meanwhile, for patients >80 years with pT2Nx-0, non-BC death risk exceeded the risk of abdominal recurrence at 1 year after RC, regardless of CCI. Conclusion: We present an alternative post-RC surveillance approach that incorporates a patient’s changing risk profile with the influence of competing health factors. We believe this strategy provides more individualized recommendations than current guidelines, and may improve the benefit derived from surveillance while reducing resource misappropriation.

Original languageEnglish (US)
Pages (from-to)1863-1869
Number of pages7
JournalWorld Journal of Urology
Volume35
Issue number12
DOIs
StatePublished - Dec 1 2017

Fingerprint

Cystectomy
Recurrence
Urinary Bladder Neoplasms
Abdomen
Neoplasms
Urethra
Pelvis
Thorax
Guidelines
Morbidity
Health

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Merrill, S., Boorjian, S. A., Thompson, R. H., Psutka, S. P., Cheville, J. C., Thapa, P., ... Frank, I. (2017). Oncologic surveillance following radical cystectomy: an individualized risk-based approach. World Journal of Urology, 35(12), 1863-1869. https://doi.org/10.1007/s00345-017-2068-7
Merrill, Suzanne ; Boorjian, Stephen A. ; Thompson, R. Houston ; Psutka, Sarah P. ; Cheville, John C. ; Thapa, Prabin ; Tollefson, Matthew K. ; Frank, Igor. / Oncologic surveillance following radical cystectomy : an individualized risk-based approach. In: World Journal of Urology. 2017 ; Vol. 35, No. 12. pp. 1863-1869.
@article{13aef3ec41d44ec7bf82ddb5743c9160,
title = "Oncologic surveillance following radical cystectomy: an individualized risk-based approach",
abstract = "Purpose: To provide an alternative surveillance approach for bladder cancer (BC) following radical cystectomy (RC) according to more accurate predictions of a patient’s projected BC course. Methods: We identified 1797 patients who underwent RC for M0 BC between 1980 and 2007. Patients were stratified by pathologic stage (pT0Nx-0, pTa/CIS/1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN+), relapse location (urethra, upper tract, abdomen/pelvis, chest, and other), age (≤60, 61–70, 71–80, >80 years) and Charlson Co-morbidity Index (CCI ≤2 and CCI ≥3). Risks of disease recurrence and non-BC death were modeled using Weibull distributions. Recommended surveillance durations were estimated when the risk of non-BC death exceeded the risk of recurrence. Results: At a median follow-up of 10.6 years (IQR 6.8,15.2), 713 patients developed recurrence. Vastly different recurrence patterns were appreciated. Specifically, among patients ≤60 years with pT2Nx-0, non-BC death risk exceeded the risk of recurrence in the abdomen at 7.5 years following surgery when CCI was ≥3, versus at year 10 after RC when CCI was ≤2. Meanwhile, for patients >80 years with pT2Nx-0, non-BC death risk exceeded the risk of abdominal recurrence at 1 year after RC, regardless of CCI. Conclusion: We present an alternative post-RC surveillance approach that incorporates a patient’s changing risk profile with the influence of competing health factors. We believe this strategy provides more individualized recommendations than current guidelines, and may improve the benefit derived from surveillance while reducing resource misappropriation.",
author = "Suzanne Merrill and Boorjian, {Stephen A.} and Thompson, {R. Houston} and Psutka, {Sarah P.} and Cheville, {John C.} and Prabin Thapa and Tollefson, {Matthew K.} and Igor Frank",
year = "2017",
month = "12",
day = "1",
doi = "10.1007/s00345-017-2068-7",
language = "English (US)",
volume = "35",
pages = "1863--1869",
journal = "World Journal of Urology",
issn = "0724-4983",
publisher = "Springer Verlag",
number = "12",

}

Merrill, S, Boorjian, SA, Thompson, RH, Psutka, SP, Cheville, JC, Thapa, P, Tollefson, MK & Frank, I 2017, 'Oncologic surveillance following radical cystectomy: an individualized risk-based approach', World Journal of Urology, vol. 35, no. 12, pp. 1863-1869. https://doi.org/10.1007/s00345-017-2068-7

Oncologic surveillance following radical cystectomy : an individualized risk-based approach. / Merrill, Suzanne; Boorjian, Stephen A.; Thompson, R. Houston; Psutka, Sarah P.; Cheville, John C.; Thapa, Prabin; Tollefson, Matthew K.; Frank, Igor.

In: World Journal of Urology, Vol. 35, No. 12, 01.12.2017, p. 1863-1869.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Oncologic surveillance following radical cystectomy

T2 - an individualized risk-based approach

AU - Merrill, Suzanne

AU - Boorjian, Stephen A.

AU - Thompson, R. Houston

AU - Psutka, Sarah P.

AU - Cheville, John C.

AU - Thapa, Prabin

AU - Tollefson, Matthew K.

AU - Frank, Igor

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Purpose: To provide an alternative surveillance approach for bladder cancer (BC) following radical cystectomy (RC) according to more accurate predictions of a patient’s projected BC course. Methods: We identified 1797 patients who underwent RC for M0 BC between 1980 and 2007. Patients were stratified by pathologic stage (pT0Nx-0, pTa/CIS/1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN+), relapse location (urethra, upper tract, abdomen/pelvis, chest, and other), age (≤60, 61–70, 71–80, >80 years) and Charlson Co-morbidity Index (CCI ≤2 and CCI ≥3). Risks of disease recurrence and non-BC death were modeled using Weibull distributions. Recommended surveillance durations were estimated when the risk of non-BC death exceeded the risk of recurrence. Results: At a median follow-up of 10.6 years (IQR 6.8,15.2), 713 patients developed recurrence. Vastly different recurrence patterns were appreciated. Specifically, among patients ≤60 years with pT2Nx-0, non-BC death risk exceeded the risk of recurrence in the abdomen at 7.5 years following surgery when CCI was ≥3, versus at year 10 after RC when CCI was ≤2. Meanwhile, for patients >80 years with pT2Nx-0, non-BC death risk exceeded the risk of abdominal recurrence at 1 year after RC, regardless of CCI. Conclusion: We present an alternative post-RC surveillance approach that incorporates a patient’s changing risk profile with the influence of competing health factors. We believe this strategy provides more individualized recommendations than current guidelines, and may improve the benefit derived from surveillance while reducing resource misappropriation.

AB - Purpose: To provide an alternative surveillance approach for bladder cancer (BC) following radical cystectomy (RC) according to more accurate predictions of a patient’s projected BC course. Methods: We identified 1797 patients who underwent RC for M0 BC between 1980 and 2007. Patients were stratified by pathologic stage (pT0Nx-0, pTa/CIS/1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN+), relapse location (urethra, upper tract, abdomen/pelvis, chest, and other), age (≤60, 61–70, 71–80, >80 years) and Charlson Co-morbidity Index (CCI ≤2 and CCI ≥3). Risks of disease recurrence and non-BC death were modeled using Weibull distributions. Recommended surveillance durations were estimated when the risk of non-BC death exceeded the risk of recurrence. Results: At a median follow-up of 10.6 years (IQR 6.8,15.2), 713 patients developed recurrence. Vastly different recurrence patterns were appreciated. Specifically, among patients ≤60 years with pT2Nx-0, non-BC death risk exceeded the risk of recurrence in the abdomen at 7.5 years following surgery when CCI was ≥3, versus at year 10 after RC when CCI was ≤2. Meanwhile, for patients >80 years with pT2Nx-0, non-BC death risk exceeded the risk of abdominal recurrence at 1 year after RC, regardless of CCI. Conclusion: We present an alternative post-RC surveillance approach that incorporates a patient’s changing risk profile with the influence of competing health factors. We believe this strategy provides more individualized recommendations than current guidelines, and may improve the benefit derived from surveillance while reducing resource misappropriation.

UR - http://www.scopus.com/inward/record.url?scp=85021922886&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021922886&partnerID=8YFLogxK

U2 - 10.1007/s00345-017-2068-7

DO - 10.1007/s00345-017-2068-7

M3 - Article

C2 - 28685181

AN - SCOPUS:85021922886

VL - 35

SP - 1863

EP - 1869

JO - World Journal of Urology

JF - World Journal of Urology

SN - 0724-4983

IS - 12

ER -