Table 3.
Multivariable analysis for recurrence, progression-free survival and overall survival
| Recurrence# | Progression-free survival$ | Overall survival$ | ||||
|---|---|---|---|---|---|---|
| Prognostic Factor | SHR (95%CI) | P | HR (95%CI) | P | HR (95%CI) | P |
| Surgery group | ||||||
| Open | 1 (Reference) | 1 (Reference) | 1 (Reference) | |||
| Robotic | 0.80 (0.49, 1.31) | 0.374 | 0.74 (0.48, 1.13) | 0.161 | 0.68 (0.43, 1.08) | 0.105 |
| Blood transfusion | ||||||
| No | 1 (Reference) | 1 (Reference) | 1 (Reference) | |||
| Yes | 1.05 (0.64, 1.72) | 0.837 | 1.17 (0.75, 1.82) | 0.484 | 1.36 (0.83, 2.21) | 0.219 |
| Chemotherapy& | ||||||
| None | 1 (Reference) | 1 (Reference) | 1 (Reference) | |||
| Neoadjuvant only | 1.15 (0.64, 2.07) | 0.646 | 1.02 (0.59, 1.78) | 0.936 | 0.97 (0.52, 1.82) | 0.918 |
| Adjuvant +/− Neoadjuvant | 1.34 (0.63, 2.85) | 0.451 | 0.83 (0.43, 1.59) | 0.574 | 0.74 (0.37, 1.47) | 0.388 |
| Other | 0.82 (0.29, 2.29) | 0.705 | 0.76 (0.34, 1.70) | 0.510 | 1.00 (0.42, 2.37) | 0.995 |
| Age in years | -- | |||||
| ≤70 | 1 (Reference) | 1 (Reference) | ||||
| >70 | 1.62 (1.06, 2.76) | 0.027 | 1.99 (1.22, 3.25) | 0.006 | ||
| ECOG performance status | -- | |||||
| 0–1 | 1 (Reference) | 1 (Reference) | ||||
| 2–3 | 3.32 (1.22, 9.08) | 0.019 | 3.67 (1.33, 10.15) | 0.012 | ||
| Pathologic stagea | ||||||
| NRD, 0a/0is, I | 1 (Reference) | 1 (Reference) | 1 (Reference) | |||
| II | 3.19 (1.28, 7.97) | 0.013 | 2.30 (1.09, 4.84) | 0.028 | 2.70 (1.14, 6.44) | 0.025 |
| III | 7.10 (2.87, 17.61) | <.0001 | 3.67 (1.84, 7.31) | 0.0002 | 4.36 (1.97, 9.62) | 0.0003 |
| IV | 7.11 (2.63, 19.23) | 0.0001 | 5.80 (2.90, 11.59) | <.0001 | 7.21 (3.27, 15.87) | <.0001 |
| Surgical margin status | ||||||
| Negative | 1 (Reference) | 1 (Reference) | 1 (Reference) | |||
| Bladder/Urethral Positive | 2.66 (1.32, 5.37) | 0.006 | 3.41 (1.77, 6.56) | 0.0002 | 3.43 (1.71, 6.90) | 0.0005 |
| Surgical complication within 90 days | -- | |||||
| Grades 0-II | 1 (Reference) | 1 (Reference) | ||||
| Grades III-V | 1.71 (1.06, 2.76) | 0.027 | 1.84 (1.10, 3.09) | 0.021 | ||
| Institution (random effects): | -- | NA | 0.152 | NA | 0.180 | |
Abbreviation: ECOG Eastern Cooperative Oncology Group Performance Status. SHR: sub-distribution hazard ratio. HR: hazard ratio. CI: confidence interval P: two-sided p-value. NA: not applicable.
The first three categories under chemotherapy include a total of 234 patients with clinical or pathological stage T2 or above. Of these, 121 received platinum-based chemotherapy (83 neoadjuvant, 31 adjuvant, and 7 both). The ”Other” category includes 68 patients as follows: 57 of stage ≤T1 who did not received chemotherapy, 7 of stage ≤T1 who received chemotherapy, and 4 who received non-platinum-based chemotherapy.
Multivariable Fine-Gray subdistribution hazards model for cumulative incidence of recurrence, with non-bladder cancer death as competing risk.
Multivariable shared-frailty Cox proportional hazards model for progression-free survival and overall survival, including shared frailty site-specific terms as random effects following a gamma distribution to account for institutional differences.
Note: The final multivariate model included arm, intraoperative blood loss, chemotherapy, and additional variables with p≤0.05. Type of urinary diversion procedure (which was a significant predictor of OS on univariate analysis) was tested for inclusion in the multivariable models, individually and jointly, but was finally excluded as it was not a statistically significant predictor of any of the three outcomes (p>0.05).