BACKGROUND: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) is associated with improved overall and cancer-specific survival. The post-NAC pathological stage has previously been reported to be a major determinant of outcome. OBJECTIVE: To develop a postoperative nomogram for survival based on pathological and clinical parameters from an international consortium. DESIGN, SETTING, AND PARTICIPANTS: Between 2000 and 2015, 1866 patients with MIBC were treated at 19 institutions in the USA, Canada, and Europe. Analysis was limited to 640 patients with adequate follow-up who had received three or more cycles of NAC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A nomogram for bladder cancer-specific mortality (BCSM) was developed by multivariable Cox regression analysis. Decision curve analysis was used to assess the model's clinical utility. RESULTS AND LIMITATIONS: A total of 640 patients were identified. Downstaging to non-MIBC (ypT1, ypTa, and ypTis) occurred in 271 patients (42 %), and 113 (17 %) achieved a complete response (ypT0N0). The 5-yr BCSM was 47.2 % (95 % confidence interval [CI]: 41.2-52.6 %). On multivariable analysis, covariates with a statistically significant association with BCSM were lymph node metastasis (hazard ratio [HR] 1.90 [95% CI: 1.4-2.6]; p < 0.001), positive surgical margins (HR 2.01 [95 % CI: 1.3-2.9]; p < 0.001), and pathological stage (with ypT0/Tis/Ta/T1 as reference: ypT2 [HR 2.77 {95 % CI: 1.7-4.6}; p < 0.001] and ypT3-4 [HR 5.9 {95 % CI: 3.8-9.3}; p < 0.001]). The area under the curve of the model predicting 5-yr BCSM after cross validation with 300 bootstraps was 75.4 % (95 % CI: 68.1-82.6 %). Decision curve analyses showed a modest net benefit for the use of the BCSM nomogram in the current cohort compared with the use of American Joint Committee on Cancer staging alone. Limitations include the retrospective study design and the lack of central pathology. CONCLUSIONS: We have developed and internally validated a nomogram predicting BCSM after NAC and radical cystectomy for MIBC. The nomogram will be useful for patient counseling and in the identification of patients at high risk for BCSM suitable for enrollment in clinical trials of adjuvant therapy. PATIENT SUMMARY: In this report, we looked at the outcomes of patients with muscle-invasive bladder cancer in a large multi-institutional population. We found that we can accurately predict death after radical surgical treatment in patients treated with chemotherapy before surgery. We conclude that the pathological report provides key factors for determining survival probability.

Cross Cancer Institute Edmonton AB Canada; Department of Oncology University of Alberta Edmonton Alberta Canada

Department of Genitourinary Oncology H Lee Moffitt Cancer Center and Research Institute Tampa FL USA

Department of Medical Oral and Biotechnological Sciences Urology Unit University G d'Annunzio Chieti Pescara Italy

Department of Medicine Division of Oncology University of Washington School of Medicine and Fred Hutchinson Cancer Research Center Seattle WA USA

Department of Medicine Division of Oncology University of Washington School of Medicine and Fred Hutchinson Cancer Research Center Seattle WA USA; Department of Hematology and Medical Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OH USA

Department of Surgery Exeter Surgical Health Services Research Unit Royal Devon and Exeter NHS Trust Exeter UK

Department of Surgery McGill University Health Center Montreal Canada

Department of Urologic Sciences University of British Columbia Vancouver Canada

Department of Urologic Surgery Vanderbilt University Medical Center Nashville TN USA

Department of Urology Freeman Hospital Newcastle Upon Tyne UK

Department of Urology Freeman Hospital Newcastle Upon Tyne UK; Department of Surgery Exeter Surgical Health Services Research Unit Royal Devon and Exeter NHS Trust Exeter UK

Department of Urology MD Anderson Cancer Center Houston TX USA

Department of Urology MD Anderson Cancer Center Houston TX USA; Department of Urology Stanford University School of Medicine Stanford CA USA

Department of Urology The James Buchanan Brady Urological Institute The Johns Hopkins School of Medicine Baltimore MD USA

Department of Urology The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology University of California at Davis Davis Medical Center Sacramento CA USA

Department of Urology University of Kansas Medical Center Kansas City KS USA

Department of Urology University of Michigan Health System Ann Arbor MI USA

Department of Urology University of Oklahoma College of Medicine Oklahoma City OK USA

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA; Department of Urology University of Münster Münster Germany

Department of Urology University of Washington Seattle WA USA

Department of Urology Weill Cornell Medical College Presbyterian Hospital New York NY USA; Department of Urology Cochin Hospital APHP Paris Descartes University Paris France

Department of Urology Weill Cornell Medical College Presbyterian Hospital New York NY USA; Department of Urology Medical University of Vienna Vienna General Hospital Vienna Austria; UT Southwestern Dallas TX USA; Charles University Prag Czech Republic; University of Jordan Amman Jordan

Glickman Urological and Kidney Institute Cleveland Clinic Cleveland OH USA; Department of Urology RUSH University Chicago IL USA

Glickman Urological and Kidney Institute Cleveland Clinic Cleveland OH USA; Fundacion Instituto Valenciano Oncologia Valencia Spain

Princess Margaret Hospital Toronto Ontario Canada

University of Alberta Edmonton Alberta Canada

USC Norris Comprehensive Cancer Center Institute of Urology University of Southern California Los Angeles CA USA

Eur Urol Focus. 2022 Sep;8(5):1559. doi: 10.1016/j.euf.2022.01.009. PubMed

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