BACKGROUND: Although the natural history of urothelial carcinoma of the bladder (UCB) from radical cystectomy (RC) to disease recurrence (DR) has been investigated intensively, the course of patients who have experienced DR after RC for UCB remains poorly understood. OBJECTIVE: To evaluate the prognostic value of the Bajorin criteria that consists of two risk factors: Karnofsky performance status (KPS) and the presence of visceral metastases (VMs) in patients with DR after RC for UCB. Furthermore, to identify additional factors associated with cancer-specific mortality (CSM) and thus build a multivariable model to predict survival after DR. DESIGN, SETTING, AND PARTICIPANTS: We identified 967 patients with UCB who underwent RC at 17 centers between 1979 and 2012 and experienced DR. Of these, 372 patients had complete data we used for analysis. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Univariable Cox regressions analysis was performed. We used a forward stepwise selection process for our final multivariable model. RESULTS AND LIMITATIONS: Within a median follow-up of 18 mo, 266 patients died of disease. Cancer-specific survival at 1 yr was 79%, 76%, and 47% for patients with no (n=105), one (n=180), and two (n=87) risk factors (p<0.001; c-index: 0.604). On multivariable analyses, we found that KPS <80%, higher American Society of Anesthesiologists score, anemia, leukocytosis, and shorter time to DR (all p values <0.034) were independently associated with increased CSM. The combination of time to DR and KPS resulted in improved discrimination (c-index: 0.694). CONCLUSIONS: We confirmed the prognostic value of KPS and VMs in patients with DR following RC for UCB. We also found several other clinical variables to be associated with worse CSM. We developed a model for predicting survival after DR inclusive of time to DR and KPS assessed at DR. If validated, this model could help clinical trial design. PATIENT SUMMARY: We developed a model to predict survival following disease recurrence after radical cystectomy for urothelial carcinoma of the bladder, based on time to disease recurrence and Karnofsky performance status.

Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York NY USA

Department of Surgery Section of Urology University of Chicago Medicine and Biological Sciences Chicago IL USA

Department of Surgical Oncological and Gastroenterologic Sciences Urology Clinic University of Padua Padua Italy

Department of Urology 2nd Faculty of Medicine Hospital Motol Charles University of Praha Praha Czech Republic

Department of Urology Caritas St Josef Medical Centre University of Regensburg Regensburg Germany

Department of Urology General Hospital of Bolzano Bolzano Italy

Department of Urology Hôpital Henri Mondor Créteil Créteil France

Department of Urology Keio University School of Medicine Shinjuku ku Tokyo Japan

Department of Urology Kitasato University School of Medicine Minami ku Sagamihara Kanagawa Japan

Department of Urology Mayo Medical School and Mayo Clinic Rochester MN USA

Department of Urology Molinette University Hospital Torino Italy

Department of Urology Rabin Medical Center Petah Tikva Israel

Department of Urology Ruhr University Bochum Marienhospital Herne Germany

Department of Urology The James Buchanan Brady Urological Institute Johns Hopkins Medical Institutions Baltimore MD USA

Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Urology University Medical Hospital of Tuebingen Tuebingen Germany

Department of Urology University of Iowa Hospitals and Clinics Iowa City IA USA

Department of Urology University of Minnesota School of Medicine Minneapolis MN USA

Department of Urology Weill Cornell Medical College New York Presbyterian Hospital New York NY USA; Department of Urology Cochin Hospital Assistance Publique Hôpitaux de Paris Paris Descartes University Paris France

Department of Urology Weill Cornell Medical College New York Presbyterian Hospital New York NY USA; Department of Urology University Hospital Basel Basel Switzerland

Department of Urology Weill Cornell Medical College New York Presbyterian Hospital New York NY USA; Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Urology Weill Cornell Medical College New York Presbyterian Hospital New York NY USA; Division of Medical Oncology Weill Cornell Medical College New York Presbyterian Hospital New York NY USA; Department of Urology Medical University of Vienna Vienna Austria

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Prognostic value of preoperative hematologic biomarkers in urothelial carcinoma of the bladder treated with radical cystectomy: a systematic review and meta-analysis