Risk stratification and conditional recurrence after radical cystectomy: toward adaptive follow‐up
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To develop a data-driven risk-stratification model to identify high-risk patients following radical cystectomy (RC) for bladder cancer and propose a risk-adapted follow-up (FU) schedule. PATIENTS AND METHODS: We performed a retrospective analysis of an individual patient data registry comprising 3196 patients with clinical T stage (cT)2-T4 N0M0 bladder cancer who underwent RC at 16 European centres (1990-2024). All treatment decisions, including the use of neoadjuvant chemotherapy, adjuvant therapy, and the FU schedule, were made at the discretion of the treating physician in accordance with the patient's preference. A Classification and Regression Tree (CART) analysis, incorporating pathological T and N stages, lymphovascular invasion (LVI), and other features, was used to stratify patients into Low-Risk and High-Risk groups for recurrence. The primary endpoint was recurrence-free survival (RFS). We used a landmark analysis to evaluate the conditional risk of recurrence at 1, 2, 3, 4, and 5 years after RC. RESULTS: At a median FU of 81.8 months, 891 patients recurred. CART analysis identified a High-Risk group (pathological T stage [pT]3-pT4, node-positive disease, or pT2 with LVI) with significantly worse 5-year RFS than the Low-Risk group (37.8% vs 76.2%; P < 0.001). This stratification was strongly prognostic for recurrence (hazard ratio [HR] 4.29; 95% confidence interval 3.63-5.00), cancer-specific survival (subdistribution HR 5.80), and overall survival (HR 3.04) (all P < 0.001). Landmark analysis confirmed that the elevated risk persisted up to 4 years; however, the conditional risk for event-free patients converged after 5 years (HR 1.37; P = 0.3). CONCLUSIONS: This study establishes a simple, pathologically derived model (pT3-4/pN+/pT2 + LVI) that effectively stratifies post-RC patients, enabling a risk-adapted FU strategy. Prospective evaluation of this framework is required to confirm its clinical utility, safety, and cost-effectiveness.
Source: British Journal of Urology
DOI: 10.1111/bju.70232
Authors: Roberto Contieri, Alberto Martini, Marc Furrer, David D’Andrea, Francesco Claps, Markus von Deimling, Francesco Soria, Andrea Mari, Lorenzo Bianchi, Elena Tonin, Ronan Flippot, Jeremy Y. C. Teoh, Gauthier Marcq, Pierre‐Emmanuel Desprez, Renate Pichler, Aleksander Ślusarczyk, José Daniel Subiela, Francesco Del Giudice, Valerio Santarelli, Angelo Porreca, Antonio Amodeo, Nicola Pavan, Alchiede Simonato, Pietro Scilipoti, Sisto Perdonà, Paolo Gontero, Bas WG van Rhijn, Rodolfo Hurle, Marco Moschini, Benjamin Pradere, Laura S. Mertens
Institutions: Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", University of Cincinnati, University of Bern, University Hospital of Bern, Solothurner Spitäler, Comprehensive Cancer Center Vienna, Medical University of Vienna, Istituto Oncologico Veneto, University Medical Center Hamburg-Eppendorf, Fondazione Ricerca Molinette, University of Turin, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Université Paris-Saclay, Institut Gustave Roussy, Fondation Gustave Roussy, Chinese University of Hong Kong, Centre National de la Recherche Scientifique, Inserm, Université de Lille, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Hôpital Claude Huriez, CANTHER - Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers, Innsbruck Medical University, Universität Innsbruck, Medical University of Warsaw, Universidad de Alcalá, Hospital Universitario Ramón y Cajal, Policlinico Umberto I, Sapienza University of Rome, Humanitas Gavazzeni, University of Palermo, IRCCS Ospedale San Raffaele, The Netherlands Cancer Institute, IRCCS Humanitas Research Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7135173447