RLC score (R status, lymphovascular invasion, C-reactive protein) predicts survival following radical cystectomy for muscle-invasive bladder cancer

Abstract

Background CRP-based scoring systems were found to correlate with survival in patients with urooncologic diseases. Our retrospective single-centre study aimed to confirm CRP as a prognostic parameter in patients with bladder cancer (BCa) undergoing radical cystectomy (RC) and, based on the findings, to develop our own outcome score for muscle-invasive bladder cancer (MIBC) patients undergoing RC in order to identify patients with a high risk of mortality.

Material and methods A total of 254 patients who underwent RC at Hanover Medical School between 1996 and 2007 were reviewed with a follow-up until autumn 2013. The clinicopathologic parameters assessed included age, co-morbidities, pre-/postoperative serum levels of CRP, leukocytes, haemoglobin, creatinine, urinary diversion, tumour grading, staging, lymph node status, lymph node density (LND), lymphovascular invasion (LVI), metastases, and resection margin status. The Chi-square test was used for univariate analyses. Kaplan-Meier estimates and the log-rank test were used for survival analyses. Regarding outcome, overall survival (OS) was assessed.

Results The multivariate analysis excluding lymph node (LN)-positive and metastatic patients at time of RC showed a significant association of R status (R; p < 0.001), LVI (L; p = 0.021) and preoperative CRP level > 5 mg/l (C; p = 0.008) with OS. Based on these parameters, the RLC score was developed. The median OS in the intermediate, high-risk and very high-risk groups according to the RLC score was 62, 22, and 6.5 months, respectively. The score had a high predictive accuracy of 0.752.

Conclusion The RLC score identifies BCa patients at a higher risk of overall mortality after RC. Overall, our study supports the role of CRP in prognostic score models for BCa.

Zusammenfassung

Hintergrund In der Vergangenheit konnte für CRP basierte Klassifizierungssysteme bereits eine Korrelation mit dem Überleben bei Patienten mit uroonkologischer Erkrankung nachgewiesen werden. Unsere retrospektive, unizentrische Studie zielte darauf ab, CRP als prognostischen Parameter für Patienten mit Harnblasenkarzinom (BCa), die sich einer radikalen Zystektomie (RC) unterziehen, zu bestätigen und basierend auf diesen Beobachtungen ein eigenes Klassifizierungssystem für muskelinvasive Harnbasenkarzinome zu entwickeln, welches Patienten mit einem hohen Mortalitätsrisiko sicher identifizieren kann.

Material und Methoden Insgesamt wurden Daten von 254 Patienten der Medizinischen Hochschule Hannover, die sich zwischen 1996 und 2007 einer RC unterzogen und bis Herbst 2013 nachbeobachtet wurden, ausgewertet. Die ausgewerteten klinisch-pathologischen Parameter umfassten u. a. das Alter, Komorbiditäten, prä- und postoperative CRP-Spiegel, Tumorgrading und -staging, Lymphknotenstatus, die lymphovaskuläre Infiltration (LVI) sowie Metastasenstatus und Resektionsränder (R-Status). Univariate Analysen wurden mittels Chi-Quadrat-Test durchgeführt. Ausgewertet wurde das Gesamtüberleben (OS).

Ergebnisse Die multivariate Analyse unter Ausschluss Lymphknoten positiver und metastasierter Patienten ergab eine signifikante Korrelation von R-Status (R; p < 0,001), LVI (L; p = 0.021) und präoperativ eleviertem CRP-Spiegel > 5 mg/l (C; p = 0,008) mit dem OS. Das mediane OS in den RLC-Risikogruppen betrug 62 Monate in der mittleren Risikogruppe, 22 Monate in der Hochrisikogruppe und 6,5 Monate in der Gruppe mit sehr hohem Risiko. Der Score hatte eine hohe Vorhersagegenauigkeit von 0,752.

Schlussfolgerung Der RLC-Score identifiziert BCa-Patienten nach RC mit einem höheren Risiko für eine erhöhte Mortalität. Insgesamt stützen unsere Daten die Rolle von CRP in prognostischen Vorhersagemodellen beim BCa.

Keywords

bladder cancer - C-reactive protein - survival score - radical cystectomy - overall survival

Schlüsselwörter

Harnblasenkarzinom - C-reaktives Protein - Überlebensscore - radikale Zystektomie - Gesamtüberleben

^* Joint first authors

Publication History

Article published online:
14 January 2021

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