Age above 70 years and Charlson Comorbidity Index higher than 3 are associated with reduced survival probabilities after radical cystectomy for bladder cancer. Data from a contemporary series of 334 consecutive patients

Abstract

Objective: To assess the joint effect of age and comorbidities on clinical outcomes of radical cystectomy (RC).Methods: 334 consecutive patients undergoing open RC for bladder cancer (BC) during the years 2005-2015 were analyzed. Pre-, peri- and post-operative parameters, including age at RC (ARC) and Charlson Comorbidity Index (CCI), were evaluated. Overall and cancer-specific survivals (OS, CSS) were assessed by univariate and multivariate modelling. Furthermore, a three-knot restricted cubic spline (RCS) was fitted to survival data to detect dependency between death-rate ratio (HR) and ARC. Results: Median follow-up time was 3.8 years (IQR = 1.3-7.5) while median OS was 5.9 years (95%CL = 3.8-9.1). Globally, 180 patients died in our cohort (53.8%), 112 of which (62.2%) from BC and 68 patients (37.8%) for unrelated causes. After adjusting for preoperative, pathological and perioperative parameters, patients with CCI > 3 showed significantly higher death rates (HR = 1.61; p = 0.022). The highest death rate was recorded in ARC = 71-76 years (HR = 2.25; p = 0.034). After fitting an RCS to both OS and CSS rates, two overlapping nonlinear trends, with common highest risk values included in ARC = 70-75 years, were observed. Conclusions: Age over 70 years and CCI > 3 were significant factors limiting the survival of RC and should both be considered when comparing current RC outcomes.

Survival outcomes of non‑definitive therapy for muscle‑invasive bladder cancer

“…Moreover, cT3 and cT4a patients had an extremely poor prognosis, with a median survival of about 313-414 days due to inadequate treatment. On the other hand, although a high CCI (≥3) and older age were not poor prognostic factors in this study, Maffezzini et al (17) reported that RC worsened the prognosis in patients older than 70 years and with a high CCI (>3). In view of this, the survival benefits, and the disadvantages of treatment-related complications associated with DT, should be carefully considered when the patients with reduced physical function choose DT.…”

Extraperitoneal cystectomy with ureterocutaneostomy derivation in fragile patients - should it be performed more often?

“…The association between some preoperative characteristics of the patients and rates of complications were previously reported in the literature (30,31). The association between perioperative hypoalbuminemia and risk of wound infection was also reported by other authors (32).…”

Is it possible to reduce the complications and mortality of patients undergoing radical cystectomy? Effectiveness of pre-operative parameters. A prospective study

“…In the study by Koppie et al, overall survival was demonstrated decreasing in patients with high comorbidity considering the comorbidity index, but recurrence-free survival was not affected. Again Maffezini et al In his study, a CCI of more than 3 was found to be associated with survival (16). It is also noteworthy that patients with high comorbidities had been performed less lymph node dissection and less postoperative chemotherapy (9).…”