Prognostic risk stratification of pathological stage T3N0 XXXX after radical cystectomy.

@entity1 @entity1803 @entity150 @entity3
PURPOSE: @entity1 with pathological T3N0 stage urothelial @entity150 show a range of outcomes after radical cystectomy. Given that nomograms have included heterogeneous groups of @entity1 , we focused on and stratified @entity1 with pT3N0 urothelial @entity150 after radical cystectomy into prognostically different risk groups to facilitate the development of adjuvant therapy trials for those at high risk. MATERIALS AND METHODS: The study comprised a total of 578 @entity1 from 9 centers worldwide with pT3N0 urothelial @entity150 who underwent radical cystectomy without perioperative chemotherapy. We evaluated the effect of @entity1803 substage at radical cystectomy, age, grade, @entity3 , margin status and number of lymph nodes removed on recurrence-free survival using Cox regression analysis. A weighted prognostic model was devised. RESULTS: Median followup was 39.4 months (IQR 64). On multivariate analysis @entity1803 substage at radical cystectomy (pT3b vs pT3a HR 2.056, p <0.0001), @entity3 (positive vs negative HR 2.004, p <0.0001) and margin status (positive vs negative HR 2.503, p = 0.002) were associated with recurrence-free survival (concordance index 0.66) in the context of generally adequate lymph node dissection, that is with a median of 17 removed. Three risk groups were devised based on weighted variables with a 5-year recurrence-free survival rate of 79% (95% CI 70-84), 57% (95% CI 50-64) and 37% (95% CI 26-48) in the low, intermediate and high risk groups, respectively. CONCLUSIONS: We constructed a user friendly prognostic risk model for @entity1 with pT3N0 urothelial @entity150 treated with radical cystectomy based on @entity1803 substage at radical cystectomy, @entity3 and margin status. These data warrant validation and may enable tailored monitoring and selection of appropriate @entity1 for adjuvant therapy trials.
