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Minerva Urology and Nephrology 2021 Jun 11

DOI: 10.23736/S2724-6051.21.04216-6


language: English

Impact of the preoperative modified glasgow prognostic score on disease outcome after radical cystectomy for urothelial carcinoma of the bladder

Victor M. SCHUETTFORT 1, 2, Kilian GUST 1, David D’Andrea 1, Fahad QUHAL 1, 3, Hadi MOSTAFAEI 1, 4, Ekaterina LAUKHTINA 1, 5, Keiichiro MORI 1, 6, Michael RINK 2, Mohammad ABUFARAJ 1, 7, Pierre I. KARAKIEWICZ 8, Stefano LUZZAGO 8, 9, Morgan ROUPRÊT 10, Dmitry ENIKEEV 5, Kristin ZIMMERMANN 11, Marina DEUKER 8, 12, Marco MOSCHINI 13, 14, Reza SARI MOTLAGH 1, 15, Nico C. GROSSMANN 1, 16, Satoshi KATAYAMA 1, 17, Benjamin PRADERE 1, 18, Shahrokh F. SHARIAT 1, 5, 7, 12, 19, 20, 21, 22

1 Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; 2 Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 3 Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia; 4 Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; 5 Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; 6 Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; 7 Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; 8 Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada; 9 Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; 10 GRC n°5, Predictive Onco-Urology, Ap-Hp, Urology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France; 11 Clinic for Urology, Central Military Hospital Koblenz, Koblenz, Germany; 12 Department of Urology, University Hospital Frankfurt, Frankfurt, Germany; 13 Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; 14 Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; 15 Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 16 Department of Urology, University Hospital Zurich, Zurich, Switzerland; 17 Department of Urology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; 18 Department of Urology, University Hospital of Tours, Tours, France; 19 Department of Urology, Weill Cornell Medical College, New York, NY, USA; 20 Department of Urology, University of Texas Southwestern, Dallas, TX, USA; 21 Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; 22 European Association of Urology Research Foundation, Arnhem, Netherlands


BACKGROUND: To investigate the predictive and prognostic value of the preoperative modified Glasgow Prognostic Score (mGPS) in patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC).
METHODS: We conducted a retrospective analysis of an established multicenter database consisting of 4,335 patients who were treated with RC +/- adjuvant chemotherapy for UCB between 1979 and 2012. The mGPS of each patient was calculated on the basis of preoperative serum C-reactive protein and albumin. Uni- and multivariable logistic and Cox regression analyses were performed. The discriminatory ability of the models was assessed by calculating the area under receiver operating characteristics curves (AUC) and concordance-indices (C-Index). The additional clinical net-benefit was assessed using the decision curve analysis (DCA).
RESULTS: A mGPS of 0, 1, and 2 was observed in 3,158 (72.8%), 1,020 (23.5%), and 157 (3.6%) patients, respectively. On multivariable logistic regression analyses, mGPS of 1 or 2 were associated with an increased risk of pT3/4 disease at RC (OR 1.25, p=0.004 and OR 2.58, p<0.001, respectively) and/or lymph node metastasis (OR 1.7, p<0.001 and OR 3.9, p<0.001, respectively). Addition of the mGPS to a predictive model based on preoperatively available variables improved its accuracy for prediction of lymph node metastasis (change of AUC +3.7%, p<0.001). On multivariable Cox regression analyses, mGPS of 1 or 2 remained associated with worse recurrence-free survival (HR 1.14, p=0.03 and HR 1.89 p<0.001, respectively), cancer-specific survival (HR 1.16, p=0.032 and HR 2.1, p<0.001, respectively) and overall survival (HR 1.5, p=0.007 and HR 1.92 p<0.001, respectively) compared to mGPS of 0. The additional discriminatory ability of the mGPS for prognosis of survival outcomes in separate models that included either established pre- or postoperative variables did not improve the C-Index by a prognostically relevant degree (change of C-Index <2% for all models). On DCA, the inclusion of the mGPS did not meaningfully improve the net-benefit for clinical decision-making regarding survival outcomes.
CONCLUSIONS: We confirmed that an elevated mGPS is an independent risk factor for non-organ confined disease and poor survival outcomes in patients with UCB undergoing RC. However, the mGPS showed little value in improving the discriminatory ability of predictive and prognostic models that relied on either pre- or postoperative clinicopathological variables. The discriminatory ability of this biomarker in the age of immunotherapy warrants further evaluation.

KEY WORDS: MIBC; NMIBC; Bladder cancer; mGPS; Biomarker; Transitional cell carcinoma

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