Abstract
Because only a few studies have evaluated conditional survival (CS) in bladder cancer patients, we examined conditional overall survival (OS) and cancer-specific survival (CSS) in these patients after radical cystectomy (RC), and determined which prognostic variables affect CS over time. We reviewed 487 patients treated with RC and pelvic lymph node dissection at our institution between 1991 and 2012. Cox regression models were used to identify the significant prognostic factors for CS depending on clinicopathological characteristics. As survival time increased after RC, conditional OS and CSS rates increased when compared with baseline survival probability. CS more significantly improved in the patients with unfavorable pathologic characteristics. While many variables were associated with survival at baseline, only age was found to be a significant prognostic factor for 5-year conditional OS in all given survivorships. In conclusion, conditional OS and CSS probabilities significantly improved over time, with greater improvements in the cases with unfavorable pathologic features. Moreover, age remained the key prognostic factor for conditional OS estimates from baseline to 5 years after surgery. Our results provide practical survival information to guide adjustments in our current follow-up strategy for bladder cancer patients after RC.
Highlights
Of 473 patients, all-cause mortality was 34.0% (N = 1 61) with a median overall survival (OS) of 164.1 months (95% confidence interval [CI] 118.3–209.9; Fig. 1A), and cancer-specific mortality was 25.6% (N = 1 21) with a median cancer-specific survival (CSS) of 180.86 months
Conditional survival (CS) provides real-time information for modified survival estimates, and it is more helpful for cancer patients to plan their remaining life and clinicians to plan surveillance strategy[13]
Sun et al.[14] reported that the 5-year cancer specific mortality (CSM)-free survival rate was 63.9% at baseline, and improved to 86.3% in patients attaining 5-year survival after surgery. They noted that survival for the initial 2 years after radical cystectomy (RC) was pivotal to the subsequent prognosis of patients
Summary
We aimed to identify the prognostic factors for the conditional OS and CSS estimates from baseline to 5 years after RC using multivariable cox proportional hazards analysis (Tables 2 and 3, respectively)
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