Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy

Froehner, Michael; Koch, Rainer; Hübler, Matthias; Heberling, Ulrike; Zastrow, Stefan; Hakenberg, Oliver W.; Wirth, Manfred P.

doi:10.1186/s12894-018-0402-z

Cited by 13 publications

(14 citation statements)

References 19 publications

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“…Data were reviewed for preoperative characteristics (age, gender, body mass index [BMI], neoadjuvant chemotherapy [NAC], American Society of Anesthesiologists [ASA] score), operative variables (operation time [skin-to-skin], EBL, type of diversion), and postoperative outcomes (staging, lymph node yield/invasion and LOS). A cut-off age of ≥80 years was used to define elderly patients [5,[15][16][17][18][19].…”

Section: Methodsmentioning

confidence: 99%

Morbidity and mortality after robot‐assisted radical cystectomy with intracorporeal urinary diversion in octogenarians: results from the European Association of Urology Robotic Urology Section Scientific Working Group

et al. 2020

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To evaluate the postoperative complication and mortality rate following laparoscopic radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in octogenarians. Patients and MethodsWe conducted a retrospective analysis comparing postoperative complication and mortality rates depending on age in a consecutive series of 1890 patients who underwent RARC with ICUD for bladder cancer between 2004 and 2018 in 10 European centres. Outcomes of patients aged <80 years and those aged ≥80 years were compared with regard to postoperative complications (Clavien-Dindo grading) and mortality rate. Cancer-specific mortality (CSM) and other-cause mortality (OCM) after surgery were calculated using the non-parametric Aalen-Johansen estimator. ResultsA total of 1726 patients aged <80 years and 164 aged ≥80 years were included in the analysis. The 30-and 90-day rate for high-grade (Clavien-Dindo grades III-V) complications were 15% and 21% for patients aged <80 years compared to 11% and 13% for patients aged ≥80 years (P = 0.2 and P = 0.03), respectively. In a multivariable logistic regression analysis adjusting for pre-and postoperative variables, age ≥80 years was not an independent predictor of high-grade complications (odds ratio 0.6, 95% confidence interval 0.3-1.1; P = 0.12). The non-cancer-related 90-day mortality was 2.3% for patients aged ≥80 years and 1.8% for those aged <80 years, respectively (P = 0.7). The estimated 12-month CSM and OCM rates for those aged <80 years were 8% and 3%, and for those aged ≥80 years, 15% and 8%, respectively (P = 0.009 and P < 0.001). ConclusionsThe minimally invasive approach to RARC with ICUD for bladder cancer in well-selected elderly patients (aged ≥80 years) achieved a tolerable high-grade complication rate; the 90-day postoperative mortality rate was driven by cancer progression and the non-cancer-related rate was equivalent to that of patients aged <80 years. However, an increased OCM rate in this elderly group after the first year should be taken into account. These results will support clinicians and patients when balancing cancer-related vs treatment-related risks and benefits.

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Section: Methodsmentioning

confidence: 99%

Morbidity and mortality after robot‐assisted radical cystectomy with intracorporeal urinary diversion in octogenarians: results from the European Association of Urology Robotic Urology Section Scientific Working Group

et al. 2020

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“…It is obvious that the predicted values of the survival analyses of the scoring systems vary in every study (4,12,16). As a matter of fact elder age (≥75), it has been reported that progressive cancer stages (T3-4) and high ASA score (≥3), increase the perioperative mortality within the 90 days period (4); make a negative impact of the five-years OS ratios through ACCI (17) and ECOG score has no additional contribution for the prediction of the 90 days mortality (4).…”

Section: Discussionmentioning

confidence: 99%

“…al (12), ASA and ECOG scores make an impact on both the 90-days perioperative mortality and the five years OS, on the other hand ACCI predicts the OS in a much more meaningful manner. Froehner et al (16) have specified that ACCI and ASA scores fail to predict the short and long-term mortality for the patients aged 80 and more, after cystectomy. According to the multivariate analysis in our study, we observed that advanced tumor stage (T3-4) and ECOG score affect PFS more significantly, and ASA score affects OS more significantly, while we could not determine the effect of patient age on oncological results.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Different Parameters for Estimating the First 90-days and Long-term Survival Following Radical Cystectomy

Selvi¹,

Başar²

2020

uob

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We aimed to define the prognostic risk factors which may have an impact on the survival by assessing the effects of the different clinical parameters and several comorbidity classifications on the oncologic outcomes within the first 90 days and long-term follow-up after radical cystectomy. Materials and Methods: Fifty-two patients who underwent radical cystectomy between June 2013-and June 2017 due to bladder tumors and whose data were fully accessible, have been assessed retrospectively. The demographical, clinical and pathologic data of the patients were recorded along with the progression and mortality rates within the first 90 days follow up period and the subsequent long-term follow-up. Age-adjusted Charlson Comorbidity index (ACCI), Eastern Cooperative Oncology Group (ECOG) score, American Society of Anesthesiologists (ASA) score, Framingham risk score, Preoperative Score to Predict Postoperative Mortality, Rockwood frailty index, preoperative serum hemogram parameters and estimated glomerular filtration rate (eGFR) were all calculated and recorded. Results: Out of the 52 patients the average age was 68.21±6.47, distant metastasis was observed in 17 (32.7%) patients during monthly follow ups at an average of 37.52±26.15 [minimum (min)=1, maximum (max)= 96], while morbidity was observed in 23 patients (44.2%). According to receiver operativing characteristic analysis, the two parameters as the most reliable tool in the prediction of the mortality during long term follow up were eGFR [area under the curve (AUC)=0.754, p<0.001] and Framingham score (AUC=0.782, p=0.001). It has also been observed in multivariate analysis that Framingham score and Clavien-Dindo classification was the most meaningful predictive factor in the estimation of the mortality in the first 90 days period, progression free survival (PFS) and overall survival (OS); eGFR for PFS and OS; ECOG score for PFS; ASA score for OS; monazite/lymphocyte rate for the estimation of the mortality in the first 90 days period. In addition, pT3-4 stage has been observed to be much more meaningful in the prediction of PFS, non-transitional cell carcinoma pathology for PFS and OS, and, lymph node positivity for OS. Conclusion: Radical cystectomy is a surgical procedure with high morbidity and mortality due to perioperative complications both in the first 90-days of the postoperative period and long-term follow-up.We found that Framingham score and eGFR were superior and easily applicable parameters in prediction of PFS and OS, whereas Framingham score and MLR were better in prediction of the first 90-days mortality. In this way, we think that we can identify patients who are more suitable for cystectomy, so we can provide more successful postoperative follow-up and treatment management.

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“…709 studies were extracted from the search of which 19 were deemed suitable for inclusion (Table 3). These studies included 1 review 45 and 18 cohort studies [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] (of which eight were from single-center data) 63 ).…”

Section: Comorbidities and Survivalmentioning

confidence: 99%

“…For all MIBC patients and those undergoing curative treatment (radical cystectomy or external beam radiotherapy), 12 of the studies concluded an association between increasing comorbidity (as defined by each study) and an increased risk of overall death. [48][49][50][53][54][55][56][57][58][59][60]62 Three studies stated the same direction of association for cancer-specific death. 54,57,61 The ways in which the studies measured comorbidity for the radical cystectomy patients varied as can be seen in Table 3.…”

Section: Comorbidities and Survivalmentioning

confidence: 99%

Systematic review of the association between socioeconomic status and bladder cancer survival with hospital type, comorbidities, and treatment delay as mediators

et al. 2021

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Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy

Cited by 13 publications

References 19 publications

Morbidity and mortality after robot‐assisted radical cystectomy with intracorporeal urinary diversion in octogenarians: results from the European Association of Urology Robotic Urology Section Scientific Working Group

Morbidity and mortality after robot‐assisted radical cystectomy with intracorporeal urinary diversion in octogenarians: results from the European Association of Urology Robotic Urology Section Scientific Working Group

Predictive Value of Different Parameters for Estimating the First 90-days and Long-term Survival Following Radical Cystectomy

Systematic review of the association between socioeconomic status and bladder cancer survival with hospital type, comorbidities, and treatment delay as mediators

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