Introduction & Objetives:
The treatment of infiltrating urothelial carcinoma is radical cystectomy with neoadjuvant platinum-based chemotherapy. Despite pathological response of 30-40%, in a proportion of patients there will be some risk factors with poor response to chemotherapeutic treatments. Currently, the approval of immunotherapy in these patients improves the overall survival. Therefore, it seems very important identify which patients have more risk of recurrence and could benefit from such therapies.
Recently, it has been developed the COBRA score (Cancer of Bladder Risk Assessment), based on the analysis of more than14000 cystectomies collected in the SEER database, it allows to predict the specific cancer survival at 2 and 5 years, based on age, pathological stage, number of lymph nodes extracted and number of affected lymph nodes.
The aim of our study is validate the score COBRA in a population of patients undergoing to radical cystectomy due to muscle-invasive urothelial carcinoma between January 2008 and December 2017 in a tertiary care hospital.
Material & methods:
We analyzed 402 patients undergoing radical cystectomy due to muscle-invasive urothelial carcinoma localized or locally advanced.
Results:
Mean age 67.7 years (31-86); 41.2% patients received neoadjuvant platinum-based chemotherapy. 35.7% of pathologic response (pT0N0). Number of lymph nodes extracted was 10.47 (0-33) with mean affectation of 0.63 lymph nodes (0-14). The specific cancer survival at 2 and 5 years was 64.3% and 33%, respectively. The average calculated COBRA score of our patients was 1.87 (0-7), with an AUC for specific cancer survival at 2 and 5 years of 0.7798 and 0.856, respectively
Conclusions:
The use of the COBRA score, as a predictor of specific cancer survival at 2 and 5 years, identifies with high precision those patients with a higher risk of cancer mortality at 2 and 5 years in our population of patients undergoing a radical cystectomy. Moreover, it could be useful for identify patients who are candidates for adjuvant treatments based on immunotherapy or under clinical trial.
