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

Abstract

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.