Comorbidity and Performance Indices as Predictors of Cancer-Independent Mortality But Not of Cancer-Specific Mortality After Radical Cystectomy for Urothelial Carcinoma of the Bladder

Mayr, Roman; May, M.; Martini, Thomas; Lodde, Michele; Comploj, Evi; Pycha, Armin; Strobel, Jenny; Denzinger, Stefan; Otto, Wolfgang; Wieland, W.F.; Burger, Maximilian; Fritsche, Hans‐Martin

doi:10.1016/j.eururo.2012.03.057

Cited by 92 publications

(71 citation statements)

References 31 publications

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“…It is an alternative to simply counting and weighing concomitant diseases and seems to be a reasonable approach for assessing the general health status. It has been identified as a predictor both of the short-term (Aziz et al 2014;Boorjian et al 2013) and the long-term mortality after radical cystectomy (Boorjian et al 2013;Mayr et al 2012). In view of this data, the statement of the current EAU guidelines regarding the ASA classification with respect to candidates for radical cystectomy ("…does not address comorbidities and should not be used in this setting."…”

Section: Discussionmentioning

confidence: 99%

441 The Lee mortality index as a comorbidity measure in patients undergoing radical cystectomy

Fröhner¹,

Koch²,

Heberling³

et al. 2015

European Urology Supplements

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Section: Discussionmentioning

confidence: 99%

441 The Lee mortality index as a comorbidity measure in patients undergoing radical cystectomy

Fröhner¹,

Koch²,

Heberling³

et al. 2015

European Urology Supplements

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“…In a retrospective study of more than 500 patients with urothelial bladder carcinoma who were subjected to cystectomy, Mayr et al demonstrated the impact of comorbidities assessed by the ASA classification on the cancer-specific mortality [26].…”

Section: Discussionmentioning

confidence: 99%

Use of the American Society of Anesthesiologists Classification as an Additional Planning Tool for Renal Cell Carcinoma Assessment

Ferreira¹,

Zéqui²,

Costa³

et al. 2013

JCT

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Objective: To determine the prognostic value of the American Society of Anesthesiologists (ASA) classification and of the main clinical pathologic variables in renal cell carcinoma (RCC) patients who underwent surgical treatment. Methods: In this international collaborative study, 376 RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) during the period 1989-2009 were assessed. The pathological data were reviewed by a single pathologist, and all of the surgically treated patients had been previously evaluated by a team of anesthesiologists and classified as ASA 1, ASA 2, or ASA 3. Results: In total, 318 patients were included in the study, with a mean followup of 48 months. Incidental tumors represented 47% of the cases, while 11.6% presented with metastases at diagnosis. Among the patients assessed, 38 (11.9%) were classified as ASA 1, 213 (67%) as ASA 2, and 67 (21.1%) as ASA 3. An association between the ASA classification and the main clinicopathological variables of RCC was observed. The univariate analysis for overall survival (OS) revealed significant differences in the survival curves according to the ASA classification (p < 0.001). High-grade neoplasms, the presence of metastasis at diagnosis, clinical stage III/IV, and incidental tumors remained as independent predictors of survival. Moreover, the multivariate analysis revealed a negative impact of the ASA classification on OS (p = 0.001). Conclusions: The present study demonstrated a correlation between the ASA classification and the main prognostic factors of RCC and its impact on survival rates. ASA 3 patients had more aggressive tumors, increased risk of perioperative complications, and worse outcomes compared with ASA1 or ASA 2. Thus, the ASA classification may be considered an additional tool for assessing and planning the treatment of RCC patients.

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“…In contrast to all of the studies that address the matter of outcome prediction in substaged pT3 UCB published to date, we were able to demonstrate that ASA 3/4 is an independent predictor of survival for the first time. Comorbidity plays a large role in the treatment and follow-up of patients with RC due to UCB [23]. Mayr et al [23] investigated the impact of severe comorbidity and performance indices on outcome in patients with UCB after RC with regard to cancer-independent mortality.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Patients with Pathological Tumor Stage T3 Urothelial Carcinoma of the Bladder following Radical Cystectomy in a Single-Center Series with 116 Patients

Breyer¹,

Denzinger²,

Otto³

et al. 2014

Urol Int

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Objective: Outcome prediction of pT3 urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) remains challenging. The objective of our study was to determine high-risk patients with poor survival outcome in a heterogeneous group substaged pT3 who might profit from early adjuvant chemotherapy. Materials and Methods: We compiled clinicopathological and immunohistochemical data of E-cadherin (E-cad) expression in 116 patients with pT3 UCB after RC in our single-center series. Multivariable Cox regression models including substaged pT3 established clinicopathological features, and the expression of the predictive immunohistochemical feature E-cad was used to identify independent predictors on progression-free (PFS), cancer-specific (CSS) and overall survival (OS), respectively. Results: No significant differences were found addressing clinicopathological data and substaged pT3. In multivariable Cox regression models, lymph node involvement was an independent predictor for PFS (p < 0.001), CSS (p < 0.001) and OS (p = 0.002), respectively. Lymphovascular invasion (LVI) significantly influenced PFS (p = 0.016). ASA score 3/4 independently predicted CSS (p = 0.049) and OS (p = 0.032). Neither pT3 substages nor E-cad expression were significant prognosticators for survival. Conclusions: In pT3 UCB patients with ASA 3/4, positive lymph node status and/or presence of LVI, administration of chemotherapy should be considered due to the high risk of poor oncological outcome. The immunohistochemical marker E-cad was not an independent predictor.

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Comorbidity and Performance Indices as Predictors of Cancer-Independent Mortality But Not of Cancer-Specific Mortality After Radical Cystectomy for Urothelial Carcinoma of the Bladder

Cited by 92 publications

References 31 publications

441 The Lee mortality index as a comorbidity measure in patients undergoing radical cystectomy

441 The Lee mortality index as a comorbidity measure in patients undergoing radical cystectomy

Use of the American Society of Anesthesiologists Classification as an Additional Planning Tool for Renal Cell Carcinoma Assessment

Outcome of Patients with Pathological Tumor Stage T3 Urothelial Carcinoma of the Bladder following Radical Cystectomy in a Single-Center Series with 116 Patients

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