Conditional survival for non-metastatic muscle-invasive adenocarcinoma of the urinary bladder after radical cystectomy.
Academic Article
Overview
abstract
PURPOSE: To test the effect of conditional survival on 36-months' cancer-specific mortality (CSM)-free survival in non-metastatic muscle-invasive adenocarcinoma of the bladder (ACB). MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2000-2018), ACB patients treated with radical cystectomy (RC) were identified. Multivariable competing risks regression (CRR) analyses assessed the independent predictor status of organ-confined (OC, T2N0M0) vs non-organ-confined stage (NOC, T3-4N0M0 or TanyN1-3M0) on CSM. Conditional 36-months' CSM-free survival estimates were computed based on event-free intervals of 12, 24, 36, 48 and 60 months after RC, according to stage. RESULTS: Of 475 ACB patients, 132 (28%) harbored OC vs 343 (72%) harbored NOC stage. In multivariable CRR models, NOC vs OC stage independently predicted lower CSM (hazard ratio 3.55; 95% CI 2.66, 5.83; p < 0.001). Conversely, neither chemotherapy nor radiotherapy were independently associated with CSM. In OC stage, 36-months' CSM-free survival rate was 84% at baseline. Provided event-free intervals of 12, 24, 36, 48 and 60 months, conditional 36-months' CSM-free survival estimates were 84, 87, 87, 89 and 89%. In NOC stage, 36-months' CSM-free survival rate was 47% at baseline. Provided event-free intervals of 12, 24, 36, 48 and 60 months, conditional 36-months' CSM-free survival estimates were 51, 62, 69, 78 and 85%. CONCLUSIONS: Conditional survival estimates provide better insight into survival of patients with longer event-free follow-up. In consequence, conditional survival estimates might be highly valuable for individual patient counselling.
