@article{oai:hirosaki.repo.nii.ac.jp:00005477,
 author = {Kusaka, Ayumu and Hatakeyama, Shingo and Hosogoe, Shogo and Hamano, Itsuto and Iwamura, Hiromichi and Fujita, Naoki and Fukushi, Ken and Narita, Takuma and Hagiwara, kazuhisa and Yamamoto, Hayato and Tobisawa, Yuki and Yoneyama, Tohru and Yoneyama, Takahiro and Hashimoto, Yasuhiro and Koie, Takuya and Ito, Hiroyuki and Yoshikawa, Kazuaki and Kawaguchi, Toshiaki and Ohyama, Chikara},
 issue = {39},
 journal = {ONCOTARGET},
 month = {Sep},
 note = {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.},
 pages = {65492--64505},
 title = {Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer},
 volume = {8},
 year = {2017}
}