Prognostic Significance of Regional Disease in Young Patients with Oral Cancer: A Comparative Study

BACKGROUND

Regional metastases are considered the most important prognostic factor in OSCC patients. We aimed to investigate the impact of regional disease among different age groups with OSCC.

METHODS

A retrospective comparison between patients 40 years old or younger, 41-69 years old, and 70 years or older treated for OSCC between 2000 and 2020 in a tertiary-care center.

RESULTS

279 patients were included. The mean age was 65 ± 17.7 and 133 were male (47.7%). Thirty-six (12.9%) were 40 years old or younger, 101 (36.2%) were 41-69 years and 142 (50.9%) were 70 years or older. Five-year overall survival and disease-specific survival (DSS) were significantly better among patients younger than 40 compared to the mid-age group and patients 70 years or older (76.7% vs. 69.4% vs.48.2%, Log-rank p < 0.001, and 76.7% vs. 75.3% vs. 46.5%, Log-rank p < 0.001, respectively). While an association between regional spread and overall survival and DSS was demonstrated among all age groups, the odds ratio (OR) for death of any cause and death of disease regarding cervical metastasis was much higher among patients younger than 40 compared with the 41-69 and 70+ age groups (death of any cause-OR = 23, p-value = 0.008, OR = 2.6, p-value = 0.026, OR = 2.4, p-value = 0.13, respectively. Death of disease-OR = 23, p-value = 0.008, OR = 2.3, p-value = 0.082, OR = 4.1, p-value = 0.001, respectively). In univariate  analysis, regional metastasis was associated with disease-free survival only among patients younger than 40 (p-value = 0.04).

CONCLUSIONS

Regional metastases correspond with worse prognosis in young patients compared to older patients. These patients may benefit from a comprehensive treatment approach with close post-treatment follow-up.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2212-2220, 2024.

A comprehensive analysis of the prognostic characteristics of microRNAs in breast cancer

Both overall survival (OS) and disease-specific survival (DSS) are significant when determining a patient's prognosis for breast cancer (BC). The effect of DSS-related microRNAs on BC susrvival, however, is not well understood. Here, we spotted differentially expressed miRNAs (DEMs) in the TCGA database of BC DSS, identified eight DSS-related miRNAs, and constructed a risk model. AUC values at 1, 3, and 5 years were 0.852, 0.861, and 0.868, respectively, indicating a risk model's excellent prognostic prediction ability. Then, we validated miRNA roles in BC OS and finally defined miR-551b as an independently prognostic miRNA in BC. According to function analysis, miR-551b is strongly linked with the emergence and spread of cancer, including protein ubiquitination, intracellular protein transport, metabolic pathways, and cancer pathways. Moreover, we confirmed the low expression of miR-551b in BC tissue and cells. After miR-551b inhibition or overexpression, cell function was either dramatically increased or diminished, respectively, indicating that miR-551b could regulate BC proliferation, invasion, and migration. In conclusion, we thoroughly clarified BC-related miRNAs on DSS and OS and verified miR-551b as a crucial regulator in the development and prognosis of cancer. These results can offer fresh ideas for BC therapy.

High expression of integrin-binding sialoprotein (IBSP) is associated with poor prognosis of osteosarcoma

INTRODUCTION

Osteosarcoma is a malignant tumor, accounting for 20% of primary malignant bone tumors worldwide. However, the role of IBSP as a biomarker in osteosarcoma progression has not been studied yet.

METHODS

85 cases of IBSP expression and clinical characteristics were obtained from TARGET database. Through the Kaplan-Meier curve, subgroup analysis, and univariate and multivariate Cox analysis, we further assessed the independent predictive capacity of IBSP expression for overall survival (OS) and relapse-free survival (RFS).

RESULTS

The mRNA expression of IBSP was higher in osteosarcoma than normal tissue (P < 0.0001). IBSP expression grouped by vital status showed statistical differences (P = 0.042). The race (P = 0.0183), vital status (P = 0.0034), and sample type (P = 0.0020) showed significant differences. IBSP expression exhibited satisfied diagnostic ability for osteosarcoma. The univariate and multivariate analysis confirmed that IBSP expression was an independent risk factor for OS (HR = 3.425, 95% CI: 1.604-7.313, P = 0.002) and RFS (HR = 3.377, 95% CI: 1.775-6.424, P < 0.001) in osteosarcoma patients. High IBSP expression was significantly associated with poor OS and RFS (P < 0.0001). The higher IBSP expression was observed in osteosarcoma (P < 0.001), confirmed by the IHC staining. The CCK-8 and colony formation assay showed that IBSP knockdown inhibits cell proliferation while overexpression promotes cell proliferation (P < 0.05).

CONCLUSION

High expression of IBSP was associated with poor OS and RFS. IBSP could serve as a potential biomarker for osteosarcoma, which could aid in early detection and disease monitoring.

High expression of TARS is associated with poor prognosis of endometrial cancer

INTRODUCTION

Endometrial cancer is the second largest and most common cancer in the world. It is urgent to explore novel biomarkers.

METHODS

Data were obtained from The Cancer Genome Atlas (TCGA) database. The receiver operating characteristic (ROC) curves, Kaplan-Meier curves and Cox analysis, nomograms, gene set enrichment analysis (GSEA) were conducted. Cell proliferation experiments were performed in Ishikawa cell.

RESULTS

TARS was significantly highly expressed in serous type, G3 grade, and deceased status. Significant association was between high TARS expression with poor overall survival (P = 0.0012) and poor disease specific survival (P = 0.0034). Significant differences were observed in advanced stage, G3 and G4, and old. The stage, diabetes, histologic grade, and TARS expression showed independent prognostic value for overall survival of endometrial cancer. The stage, histologic grade, and TARS expression showed independent prognostic value for disease specific survival of endometrial cancer. Activated CD4⁺ T cell, effector memory CD4⁺ T cell, memory B cell and type 2 T helper cell may participate in the high TARS expression related immune response in endometrial cancer. The CCK-8 results showed significantly inhibited cell proliferation in si-TARS (P < 0.05) and promoted cell proliferation in O-TARS (P < 0.05), confirmed by the colony formation and live/dead staining.

CONCLUSION

High TARS expression was found in endometrial cancer with prognostic and predictive value. This study will provide new biomarker TARS for diagnosis and prognosis of endometrial cancer.

Similar Stage-dependent Survival and Outcome in Sporadic and Hereditary Medullary Thyroid Carcinoma

CONTEXT

Long-term data are scarce on large cohorts with sporadic (sMTC) and hereditary medullary thyroid carcinoma (hMTC).

OBJECTIVES

To compare long-term disease-specific survival (DSS) and outcomes between sMTC and hMTC groups.

DESIGN

Retrospective analysis.

SETTING

German tertiary referral center.

PATIENTS

A total of 673 patients with MTC that underwent surgery from January 1974 to July 2019.

INTERVENTION

None (observational study).

MAIN OUTCOME MEASURE

Differences between sMTC and hMTC in long-term, stage-dependent survival and outcomes.

RESULTS

Surgery was performed at median ages of 49 years for sMTC (n = 477, 44% male) and 29 years for hMTC (n = 196, 43% male; P < 0.0001). The mean follow-up times were 9.2 ± 8.0 (sMTC) and 14.6 ± 10.3 years (hMTC). Age and tumor stage at diagnosis were significantly different between the 2 groups (P < 0.0001). The sMTC and hMTC groups had different overall DSS (log rank, P = 0.0183), but similar stage-dependent DSS (log rank, P = 0.1242-0.8981). In a multivariate analysis, sMTC and hMTC did not differ in DSS (hazard ratio [HR] = 1.56; 95% CI, 0.94-2.57), but in both groups, a worse DSS was significantly associated with age at diagnosis (HR = 1.04; 95% CI, 1.02-1.05), male sex (HR = 0.49; 95% CI, 0.32-0.76), and stages III and IV at diagnosis (HR = 20.00; 95% CI, 2.74-145.91 and HR = 97.47; 95% CI, 13.07-726.67, respectively). The groups had significantly different (P < 0.0001) outcomes (i.e., cured, minimal residual disease, structural detectable disease, and death), but similar stage-dependent outcomes (P = 0.9449-0.0511), except for stage III (P = 0.0489).

CONCLUSION

Patients with sMTC and hMTC had different ages of onset, but similar stage-dependent DSS and outcomes after the MTC diagnosis. This finding suggested that tumor behavior was similar in sMTC and hMTC.

Basal Cell Carcinoma of the External Genitalia: A Population-Based Analysis

Introduction

Basal cell carcinoma (BCC) located on the genitalia is rare; data on the clinicopathologic features and survival outcomes are only available through case reports and small case series studies.

Purpose

This study aimed to explore the epidemiology and identify the prognostic factors of genital BCCs.

Methods

We queried the 18 registries of the Surveillance, Epidemiology, and End Results database for patients with primary BCCs of the genital skin from 2000 through 2017. The primary endpoint was overall survival (OS) and disease specific survival (DSS). Kaplan-Meier survival analysis was conducted to assess the impact of clinicopathological variables on OS and DSS. Multivariate Cox proportional hazards model was performed to evaluate risk factors for OS.

Results

A total of 1,607 cases of genital BCCs were identified. The cohort was composed of 1,352 women (84.1%) and 255 men (15.9%). The median (P25, P75) age of the entire cohort was 73(63–82)years. White patients accounted for 87.2% of the cases. For women and men, the most common site of involvement was the labia majora (89.6%) and scrotum (74.5%), respectively. The majority of patients with genital BCC had localized disease (75.5%). Kaplan-Meier survival analysis showed that female genital BCCs experienced better DSS than men (209.1 months vs 194.8 months); for men, BCCs located on the scrotum had better DSS and OS than those on the penis (P < 0.05 for both endpoints). All patients with distant disease died of disease-specific death, and the average survival time was 8.2 months. Multivariate analysis revealed that age, primary site, and stage were independent determinants of OS for men, while tumor size, histologic subtype, and race were not. For women, factors associated with worse OS included increasing age, tumor size more than 2 cm, and distant disease; factors associated with a decreased risk included “other” and “unknown” races.

Conclusion

The prognosis of genital BCCs is excellent, while the survival of distant disease is very poor. Despite similar clinicopathologic features and overall survival outcomes, men and women should be treated as two different entities when making survival predictions.

Retrospective analysis of prognostic factors affecting the recurrence and disease-free survival following surgical management of gastrointestinal stromal tumors

Objectives

The aim of this study was to evaluate the prognostic factors effecting recurrence risk and disease-free survival of the patients who were diagnosed as gastrointestinal stromal tumor after complete resection of the tumor with or without adjuvant therapy.

Material and Methods

Between the years 2005 and 2013, data of 71 patients including clinical and demographic features, tumor localizations, pathologic examinations, survival and recurrence rates were enrolled into this retrospective study.

Results

Male/female ratio was 1.71, and mean age was 60.27 ± 14.65 years. Forty-two (59.2%) patients had tumor in stomach, 16 (22.5%) in small bowel, whereas 12 (16.9%) had extra-gastrointestinal system and one patient (%1.4) had rectal localization. Modified NIH risk stratification scheme categorized 9 (12.68%) patients in very low-, 12 (16.90%) in low-, 21 (29.58%) patients in moderate-and 29 (40.85%) patients in high-risk group. Twenty-four (33.8%) patients had a metastatic disease at follow-up while 13 (18.3%) patients were metastatic at admission. R0 resection was successfully performed in 51 (71.8%) patients, while R1 resection in 9 (12.7%) and R2 resection in 11 (15.5%) were achieved. Mean follow-up time was 47.12 ± 33.52 months (range, 1-171 months). Nineteen (26.8%) patients demonstrated recurrence with a mean time of 22.16 ± 15.89 months (range, 3-57 months). During follow-up 17 (23.9%) patients were deceased. In univariate analysis, high-risk group, small bowel and extra-gastrointestinal system localization, R1-2 resection, necrosis, positive resection margin and invasion of surrounding tissues, metastatic disease and adjuvant therapy were statistically significant in terms of recurrence. Multivariate analysis presented small bowel and extra-gastrointestinal system localization, R2 resection, mitoses count, invasion and adjuvant therapy as independent prognostic risk factors affecting disease-free survival rates. The 1, 3 and 5 years of disease-free survival rates of the patients were 89.6%, 75.4%, 64.3%, respectively.

Conclusion

As mentioned in the literature, the mainstay of curative therapy of gastrointestinal stromal tumor is surgery. In our study, not only small bowel, extra-gastrointestinal system localization and invasion of surrounding tissues by tumor, but also R2 resection that complicate the local control of the disease were represented as independent adverse prognostic factors for disease-free survival. Unfavourable clinical outcomes of adjuvant therapy over the disease-free survival was linked to higher tumor stage with metastatic disease and emphasized that prospective trials with more cases should be practiced.

Impact of baseline BMI and weight change in CCTG adjuvant breast cancer trials

Background

We hypothesized that increased baseline BMI and BMI change would negatively impact clinical outcomes with adjuvant breast cancer systemic therapy.

Methods

Data from chemotherapy trials MA.5 and MA.21; endocrine therapy MA.12, MA.14 and MA.27; and trastuzumab HERA/MA.24 were analyzed. The primary objective was to examine the effect of BMI change on breast cancer-free interval (BCFI) landmarked at 5 years; secondary objectives included BMI changes at 1 and 3 years; BMI changes on disease-specific survival (DSS) and overall survival (OS); and effects of baseline BMI. Stratified analyses included trial therapy and composite trial stratification factors.

Results

In pre-/peri-/early post-menopausal chemotherapy trials (N = 2793), baseline BMI did not impact any endpoint and increased BMI from baseline did not significantly affect BCFI (P = 0.85) after 5 years although it was associated with worse BCFI (P = 0.03) and DSS (P = 0.07) after 1 year. BMI increase by 3 and 5 years was associated with better DSS (P = 0.01; 0.01) and OS (P = 0.003; 0.05). In pre-menopausal endocrine therapy trial MA.12 (N = 672), patients with higher baseline BMI had worse BCFI (P = 0.02) after 1 year, worse DSS (P = 0.05; 0.004) after 1 and 5 years and worse OS (P = 0.01) after 5 years. Increased BMI did not impact BCFI (P = 0.90) after 5 years, although it was associated with worse BCFI (P = 0.01) after 1 year. In post-menopausal endocrine therapy trials MA.14 and MA.27 (N = 8236), baseline BMI did not significantly impact outcome for any endpoint. BMI change did not impact BCFI or DSS after 1 or 3 years, although a mean increased BMI of 0.3 was associated with better OS (P = 0.02) after 1 year. With the administration of trastuzumab (N = 1395) baseline BMI and BMI change did not significantly impact outcomes.

Conclusions

Higher baseline BMI and BMI increases negatively affected outcomes only in pre-/peri-/early post-menopausal trial patients. Otherwise, BMI increases similar to those expected in healthy women either did not impact outcome or were associated with better outcomes.

Clinical Trials numbers

CAN-NCIC-MA5; National Cancer Institute (NCI)-V90-0027; MA.12-NCT00002542; MA.14-NCT00002864; MA.21-NCT00014222; HERA, NCT00045032;CAN-NCIC-MA24; MA-27-NCT00066573.

Development and external validation of a prognostic nomogram for gastric cancer using the national cancer registry

A nomogram based on both western and eastern populations to estimate the Disease Specific Survival (DSS) of resectable gastric cancer (RGC) has not been established. In current study, we retrospectively analyzed 4,379 RGC patients who underwent curative resection from the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed between 1998 and 2009 were assigned as training set (n= 2,770), and the rest were selected as SEER validation set (n= 1,609). An external validation was performed by a set of independent 1,358 RGC patients after D2 resection from Sun Yat–sen University Cancer Center (SYSUCC) in China. The nomogram was constructed based on the training set. The multivariate analysis identified that patient's age at diagnosis, race, tumor location, grade, depth of invasion, metastatic lymph node stage (mLNS) and total number of examined lymph node (TLN) were associated with patient's DSS. The discrimination of this nomogram was superior to that of the 7th edition of AJCC staging system in SEER validation set and SYSUCC validation set (0.73 versus 0.70, p=0.005; 0.76 versus 0.72, p=0.005; respectively). Calibration plots of the nomogram showed that the probability of DSS corresponded to actual observation closely. In conclusion, our nomogram resulted in more–reliable prognostic prediction for RGC patients in general population.

Survival in patients with medullary thyroid cancer after less than the recommended initial operation

BACKGROUND AND OBJECTIVES

We aimed to evaluate the disease specific-survival (DSS) of patients with Medullary Thyroid Cancer (MTC) confined to the central neck based on the extent of the initial operation.

METHODS

This retrospective review of patients with MTC from the SEER registry from 2004 to 2012 excluded patients with lateral neck involvement or distant metastases.

RESULTS

The cohort (n = 766) included 85(11%) less than total thyroidectomies (TT), 212(28%) TT alone, and 469(61%) TT with lymph node excision. Mean tumor size was similar (2.2cm for <TT, 1.9 for TT alone, and 2.2 for TT with nodes, p=0.13). Patients receiving a TT with nodal excision were more likely to have multifocal tumors (8% <TT, 22% TT alone, and 27% TT with nodes, P < 0.001), and extrathyroidal extension (1% <TT, 4% TT alone, and 9% TT with nodes, P = 0.005). Even after controlling for significant predictors of DSS, extent of the initial operation did not predict survival (HR 0.28 for <TT, 95% CI 0.26-3.11 and HR 0.62 for TT alone, 95% CI 0.17-2.22 compared to TT with nodes, P = NS for all).

CONCLUSION

According to population-based SEER registry data, the extent of initial resection may not significantly change DSS in patients with MTC confined to the central neck.

Impact of neoadjuvant and adjuvant radiotherapy on disease-specific survival in patients with stages II-IV rectal cancer

Objectives

The purposes of this study were to determine whether neoadjuvant or adjuvant radiotherapy affected disease-specific survival (DSS) in patients with rectal cancer and whether stratification by tumor stage affected the results.

Results

55.5% patients had neoadjuvant-radiotherapy (NRT), and 18.3% patients had adjuvant- radiotherapy (ART). Multivariable models showed that treatment type was independently associated with DSS. Patients with stages III/IV tumors who received ART plus chemotherapy had significantly worse DSS than did those who received NRT plus chemotherapy (NCRT) (P = 0.03). Among patients with stage II tumors, those who received ART plus chemotherapy and those who received NCRT had similar DSS. Further stratification by risk group revealed that patients with stage IIIA tumors who received ART plus chemotherapy had significantly better DSS than did those who received NCRT (P = 0.04). The ART plus chemotherapy and NCRT groups had similar DSS in patients with stage IIA tumors. Among high-risk patients (T3N+/T4), the NCRT group had significantly better DSS than did the ART plus chemotherapy group. Patients who underwent surgery only had the worst DSS of all the treatment groups.

Materials and Methods

From the Surveillance, Epidemiology, and End Results database, patients diagnosed with stages II-IV rectal cancer from 2004-2014 were identified. Clinicopathologic features, treatments, and DSS in different treatment groups were compared.

Conclusions

NCRT or ART plus chemotherapy can reduce deaths from rectal cancer. Patients with stage IIIA tumors will benefit most from ART plus chemotherapy, whereas NCRT should be recommended to patients with stages II, IIIB, or higher tumors.

Geographic region: Does it matter in cutaneous melanoma of the head and neck?

OBJECTIVES/HYPOTHESIS

The head and neck are two of the most common locations for cutaneous melanoma. We present the first population-based analysis of geographic differences in anatomic subsite, clinicopathologic and demographical traits, histopathologic subtype, treatment modality, and disease-specific survival (DSS) of cutaneous head and neck melanoma (CHNM).

STUDY DESIGN

Retrospective database analysis.

METHODS

The Surveillance, Epidemiology, and End Results database was queried for cases of CHNM reported between 2000 and 2013. Patients were grouped into East, Midwest, South, and West regions of the United States. Overall incidence, demographic traits, primary tumor site, clinicopathologic traits, histopathologic subtype, treatment modality, and DSS were compared among regions.

RESULTS

There were 49,365 patients with CHNM identified. The West (4.60) and the South (4.42) had significantly higher incidence (per 100,000) than the East (3.84) and Midwest (3.65) (P < .05). DSS was significantly different among regions (P < .0066). The East (5 years: 89.4%, 10 years: 84.1%) had the highest DSS rate, and the South (5 years: 87.0%, 10 years: 81.8%) had the lowest DSS rate. The Midwest (5 years: 88.4%, 10 years: 84.3%) and West (5 years: 88.3%, 10 years: 83.5%) had intermediate DSS. On multivariate analysis, the South had an elevated hazard ratio (1.17, 95% confidence interval: 1.05-1.30) when compared to the West.

CONCLUSIONS

Geographic region may play a significant role in CHNM. Incidence is higher in the South and the West. Incidence, histologic subtype, treatment modality, and DSS vary among regions. DSS is lower in the South than the West, even after accounting for other major prognostic factors.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:2763-2769, 2017.

Genetic variants in the PIWI-piRNA pathway gene DCP1A predict melanoma disease-specific survival

The Piwi-piRNA pathway is important for germ cell maintenance, genome integrity, DNA methylation and retrotransposon control and thus may be involved in cancer development. In this study, we comprehensively analyzed prognostic roles of 3,116 common SNPs in PIWI-piRNA pathway genes in melanoma disease-specific survival. A published genome-wide association study (GWAS) by The University of Texas M.D. Anderson Cancer Center was used to identify associated SNPs, which were later validated by another GWAS from the Harvard Nurses' Health Study and Health Professionals Follow-up Study. After multiple testing correction, we found that there were 27 common SNPs in two genes (PIWIL4 and DCP1A) with false discovery rate < 0.2 in the discovery dataset. Three tagSNPs (i.e., rs7933369 and rs508485 in PIWIL4; rs11551405 in DCP1A) were replicated. The rs11551405 A allele, located at the 3' UTR microRNA binding site of DCP1A, was associated with an increased risk of melanoma disease-specific death in both discovery dataset [adjusted Hazards ratio (HR) = 1.66, 95% confidence interval (CI) = 1.21-2.27, p =1.50 × 10^-3 ] and validation dataset (HR = 1.55, 95% CI = 1.03-2.34, p = 0.038), compared with the C allele, and their meta-analysis showed an HR of 1.62 (95% CI, 1.26-2.08, p =1.55 × 10^-4 ). Using RNA-seq data from the 1000 Genomes Project, we found that DCP1A mRNA expression levels increased significantly with the A allele number of rs11551405. Additional large, prospective studies are needed to validate these findings.

Perioperative radiotherapy is associated with improved survival among patients with synovial sarcoma: A SEER analysis

BACKGROUND AND METHODS

We examined the outcomes of synovial sarcoma (SS) patients in a national database. We identified 1,189 patients from the Surveillance, Epidemiology, and End Results (SEER) database with data on site and extent of surgery. We excluded patients diagnosed before 1990, <18 years, or lacking pathologic confirmation. Using Kaplan-Meier and Cox proportional hazards analyses, we determined predictors of overall (OS) and disease-specific survival (DSS).

RESULTS

The mean age was 41, 49.3% were female, and 82.2% were white. Radiotherapy (RT) was administered to 57.5%. On multivariable analysis, age at diagnosis, sex, race, anatomic site, SEER summary stage, tumor size, surgery type, and RT predicted OS. Similar predictors of DSS were identified. The hazard ratio (HR) for OS was 0.65 (95% CI 0.48-0.88) in favor of RT and 0.62 (95% CI 0.45-0.86) for DSS. Five-year OS improved 8.4 ± 1.0% with RT (P=0.003), and five-year DSS improved 7.7 ± 1.0% with RT (P=0.015).

CONCLUSIONS

In the largest study to date examining the role of RT in synovial sarcoma, we observed that RT was associated with a statistically significant improvement in oncologic outcome among SS patients. These data support the use of RT in the multi-modality treatment of patients with SS.

Refining patient selection for neoadjuvant chemotherapy before radical cystectomy

PURPOSE

We evaluated the survival of patients with muscle invasive bladder cancer undergoing radical cystectomy without neoadjuvant chemotherapy to confirm the utility of existing clinical tools to identify low risk patients who could be treated with radical cystectomy alone and a high risk group most likely to benefit from neoadjuvant chemotherapy.

MATERIALS AND METHODS

We identified patients with muscle invasive bladder cancer who underwent radical cystectomy without neoadjuvant chemotherapy at our institution between 2000 and 2010. Patients were considered high risk based on the clinical presence of hydroureteronephrosis, cT3b-T4a disease, and/or histological evidence of lymphovascular invasion, micropapillary or neuroendocrine features on transurethral resection. We evaluated survival (disease specific, progression-free and overall) and rate of pathological up staging. An independent cohort of patients from another institution was used to confirm our findings.

RESULTS

We identified 98 high risk and 199 low risk patients eligible for analysis. High risk patients exhibited decreased 5-year overall survival (47.0% vs 64.8%) and decreased disease specific (64.3% vs 83.5%) and progression-free (62.0% vs 84.1%) survival probabilities compared to low risk patients (p <0.001). Survival outcomes were confirmed in the validation subset. On final pathology 49.2% of low risk patients had disease up staged.

CONCLUSIONS

The 5-year disease specific survival of low risk patients was greater than 80%, supporting the distinction of high risk and low risk muscle invasive bladder cancer. The presence of high risk features identifies patients with a poor prognosis who are most likely to benefit from neoadjuvant chemotherapy, while many of those with low risk disease can undergo surgery up front with good expectations and avoid chemotherapy associated toxicity.