1410 DEVELOPMENT OF A NEW OUTCOME PREDICTION MODEL FOR PATIENTS WITH INVASIVE BLADDER CANCER BASED ON PREOPERATIVE SERUM CRP AND STANDARD PATHOLOGIC RISK FACTORS: THE TNR-C SCORE

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111410 DEVELOPMENT OF A NEW OUTCOME PREDICTION MODEL FOR PATIENTS WITH INVASIVE BLADDER CANCER BASED ON PREOPERATIVE SERUM CRP AND STANDARD PATHOLOGIC RISK FACTORS: THE TNR-C SCORE Georgios Gakis, Tilman Todenhoefer, Markus Renninger, David Schilling, Christian Schwentner, Karl-Dietrich Sievert, and Arnulf Stenzl Georgios GakisGeorgios Gakis Tuebingen, Germany More articles by this author , Tilman TodenhoeferTilman Todenhoefer Tuebingen, Germany More articles by this author , Markus RenningerMarkus Renninger Tuebingen, Germany More articles by this author , David SchillingDavid Schilling Tuebingen, Germany More articles by this author , Christian SchwentnerChristian Schwentner Tuebingen, Germany More articles by this author , Karl-Dietrich SievertKarl-Dietrich Sievert Tuebingen, Germany More articles by this author , and Arnulf StenzlArnulf Stenzl Tuebingen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1301AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the predictive value of preoperative C-reactive protein (CRP) in patients undergoing radical cystectomy (RC) for invasive bladder cancer in light of recent data showing it to be an independent indicator of adverse oncological outcome in other malignancies. METHODS A contemporary, consecutive cohort of 246 patients undergoing RC and bilateral pelvic lymphadenectomy for bladder cancer between 1999–2009. Elevated CRP was defined as >0.5 mg/dL. The median follow-up was 30 months (6–116). Fisher Exact test and Cox-regression analysis were used for uni- and multivariate analysis of risk factors, and Kaplan-Meier analysis for cancer-specific survival (CSS). Furthermore, a new scoring model was developed to predict cancer-specific outcomes. The predictive accuracy of the model was evaluated using the concordance index. RESULTS Normal (≤0.5mg/dl) and elevated CRP (>0.5mg/dl) was present in 120 and 126 patients, respectively. The 3-year-CSS was 74.0% in patients with normal and 44.0% with elevated CRP (p<0.001). In univariate analysis, elevated CRP was significantly associated with advanced tumor stage, lymph node density ≥0.09, increased tumor size (all p<0.001), increased age (p=0.003) and positive resection margins (p=0.026). No significant differences were found for: gender, multifocality, grade, non-urothelial cancer pathology, preoperative leukocyte count, and postoperative chemotherapy. In multivariate analysis, CSS was significantly lower in patients with elevated CRP (HR: 1.18; 1.08–1.27, p<0.001; used as a continuous variable), advanced tumor stage (HR 2.54; 0.99–4.17, p=0.001), LN-density ≥0.09 (HR: 2.04; 0.32–3.63, p=0.02) and positive resection margins (HR: 4.02, 1.91–6.01, p<0.001). Based on the regression estimates of significant parameters in multivariate analysis a new CRP-based scoring model was defined. The 3-yr CSS in patients with a score 0–2, 3–6 and 7–10 was 80.5%, 44.9% and 7.1%, respectively (p<0.001). Consideration of CRP in the final model increased its predictive accuracy by 4.9% with a concordance index of 0.788 (p=0.01). CONCLUSIONS This is the largest contemporary series to date indicating that preoperative CRP, used as a continuous variable, is an independent risk factor for CSS. Furthermore, a new and simple CRP-based scoring model, termed TNR-C score, improved significantly the predictive accuracy of standard pathologic risk factors. Therefore, serum CRP level may be a useful outcome parameter to include in bladder cancer nomograms. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e564-e565 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Georgios Gakis Tuebingen, Germany More articles by this author Tilman Todenhoefer Tuebingen, Germany More articles by this author Markus Renninger Tuebingen, Germany More articles by this author David Schilling Tuebingen, Germany More articles by this author Christian Schwentner Tuebingen, Germany More articles by this author Karl-Dietrich Sievert Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...