Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer
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Ayumu Kusaka1, Shingo Hatakeyama1, Shogo Hosogoe1, Itsuto Hamano1, Hiromichi Iwamura1, Naoki Fujita1, Ken Fukushi1, Takuma Narita1, Kazuhisa Hagiwara1, Hayato Yamamoto1, Yuki Tobisawa1, Tohru Yoneyama2, Takahiro Yoneyama1, Yasuhiro Hashimoto2, Takuya Koie1, Hiroyuki Ito3, Kazuaki Yoshikawa4, Toshiaki Kawaguchi5 and Chikara Ohyama1,2
1Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
2Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
3Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
4Department of Urology, Mutsu General Hospital, Mutsu, Japan
5Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
Shingo Hatakeyama, email: [email protected]
Keywords: medical cost, radical cystectomy, recurrence, screening, surveillance
Received: March 07, 2017 Accepted: June 20, 2017 Published: July 06, 2017
Background: The recurrence risk stratification and the cost effectiveness of oncological surveillance after radical cystectomy are not clear. We aimed to develop a risk stratification and a surveillance protocol with improved cost effectiveness after radical cystectomy.
Results: Of 581 enrolled patients, 175 experienced disease recurrences. The pathology-based protocol presented significant differences in recurrence-free survival between normal- and high-risk patients, but the medical expense was high, especially in normal-risk (≤pT2pN0) patients. Cox regression analysis identified six factors associated with recurrence-free survival. Risk score-based 5-year follow-up was significantly more cost effective than the pathology-based protocol.
Materials and Methods: We retrospectively evaluated 581 patients with radical cystectomy for muscle-invasive bladder cancer at 4 hospitals. Patients with routine oncological follow-up were stratified into normal- and high-risk groups by a pathology-based protocol utilizing pT, pN, lymphovascular invasion, and histology. Cost effectiveness of the pathology-based protocol was evaluated and a risk-score-based protocol was developed to optimize cost effectiveness. Risk-scores were calculated by summing risk factors independently associated with recurrence-free survival. Patients were stratified by low-, intermediate-, and high-risk score. Estimated cost per one recurrence detection by the pathology and by risk-scores were compared.
Conclusions: Risk-score-stratified surveillance protocol has potential to reduce over-evaluation after radical cystectomy without adverse effects on medical cost.
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