Use of preoperative performance status and hemoglobin concentration to predict overall survival for patients aged ≥75 years after radical cystectomy for treatment of bladder cancer

Hara, Takahiko; Matsuyama, Hideyasu; Kamiryo, Yoriaki; Hayashida, Shigeaki; Yamamoto, Norio; Nasu, Tetsuo; Joko, Keiji; Baba, Yasunori; Suga, Atsushi; Yamamoto, Miyuki; Arakawa, Akihiko; Takai, Kimio; Yoshihiro, Satoru; Konishi, M; Sakano, Sigeru; Imoto, Katsuhiko; Tei, Yasuhide; Yamaguchi, S.; Yano, Seiji

doi:10.1007/s10147-015-0857-9

Cited by 28 publications

(18 citation statements)

References 21 publications

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“…Overall and cancer-specific survival outcomes following radical cystectomy have remained unaltered over the last three decades, with 5-yr overall survival between 50% and 60% [17,19,35]. Numerous studies have confirmed the association between comorbidity status and survival outcomes following radical cystectomy [9,10,17,19,36–46]. However, no comorbidity index has demonstrated superiority in predicting survival outcomes.…”

Section: Evidence Synthesismentioning

confidence: 99%

Systematic Review of Comorbidity and Competing-risks Assessments for Bladder Cancer Patients

Williams

Kamat

Chamie

et al. 2018

European Urology Oncology

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Context Radical cystectomy continues to be associated with a significant risk of morbidity and all-cause mortality (ACM). Practice pattern data demonstrating underuse of surgery for patients with muscle-invasive and high-risk non–muscle invasive bladder cancer (BC) have been linked to the advanced age and higher comorbidity status of such patients, which suggests that rates of ACM as well as cancer-specific mortality should be incorporated into patient counseling and guideline recommendations. Objective To review the literature on risk assessment tools for preoperative comorbidity in BC that may aid in treatment decision-making. Evidence acquisition A systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on comorbidity risk assessment (CRA) tools for BC. Prospective and retrospective studies were included. Evidence synthesis There are no published randomized control trials comparing CRA tools for BC. Patients undergoing radical cystectomy with combined high-risk comorbidity and performance scores may face up to a sevenfold greater risk of other-cause mortality compared to those with low scores. The Charlson Comorbidity Index is one of the most widely studied indices for 90-d perioperative mortality and overall and cancer-specific survival, with an area under the receiver operating characteristic curve of up to 0.810. Prospective studies of CRA tools for BC have consistently shown that patients with higher comorbidity have worse outcomes. While not specific for BC, comorbidity indices provide useful assessment of competing risks. Competing-risks assessment tools are lacking, with limited studies assessing the impact of these tools on treatment decision-making by patients and providers. We provide the impetus for incorporation of comorbidity risks into practice guidelines when discussing treatment options with patients. Conclusions CRA tools should be incorporated into preoperative treatment counseling and the assessment of postoperative outcomes. While retrospective evidence supports the use of CRA tools for BC, further comparative studies evaluating the effectiveness of these tools and identifying the patients most likely to benefit from a treatment according to competing-risks assessment are needed. Patient summary In this review we explored the clinical evidence for comorbidity risk assessment tools in bladder cancer. We found evidence to support incorporation of comorbidity risks into practice guidelines when discussing treatment options with patients.

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Section: Evidence Synthesismentioning

confidence: 99%

Systematic Review of Comorbidity and Competing-risks Assessments for Bladder Cancer Patients

Williams

Kamat

Chamie

et al. 2018

European Urology Oncology

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“…Both of these conditions are considered risk factors of post-radical cystectomy complications [20][21][22][23]. Surprisingly, low haemoglobin concentration was found to be predictor of radical cystectomy in the current cohort, despite elsewhere demonstrated negative impact on postoperative survival [24,25]. An analysis of the SEER database by Canter et al revealed that less than 5% of patients with high-grade T1 disease underwent immediate cystectomy.…”

Section: Discussionmentioning

confidence: 87%

Predictors and prognostic implications of clinical decisions in patients with primary high-risk non-muscle-invasive bladder cancer – results of a cross country retrospective study

Poletajew¹,

Biernacki²,

Buraczyński³

et al. 2018

neo

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Adjuvant diagnostic and therapeutic procedures are available to reduce the risk of recurrence or progression in patients with high-risk non-muscle-invasive bladder cancer (NMIBC). However, their indications and efficacy remain a matter of debate. The aim of this study was to analyze therapeutic decisions in patients with primary high-risk NMIBC and to analyze the adherence to clinical guidelines in this field.545 consecutive patients, aged a median of 70.3 years, diagnosed with primary high-risk NMIBC in thirteen urological institutions, were enrolled into this retrospective study. Diagnostic and therapeutic decisions after transurethral resection (TUR) were recorded, and predictive factors were analyzed.Restaging TUR was offered to 260 patients (47.7%), up-front intravesical Bacillus Calmette-Guerin (BCG) therapy to 74 patients (13.6%), immediate radical cystectomy to 38 patients (7.0%), and intravesical chemotherapy with the maintenance therapy to 12 patients (2.2%). No additional procedure was performed in 161 patients (29.5%). The strongest predictive factor for restaging TUR was G3 or high-grade cancer (RR 1.68, p<0.01), for upfront BCG therapy it was carcinoma in situ (RR 3.20, p=0.01), for immediate cystectomy it was stage T1 tumor (RR 3.71, p<0.01), for no additional procedures it was G2 or low-grade cancer (RR 2.18, p<0.01).Clinical management of patients with high-risk NMIBC is suboptimal and not standardized. As this can directly influence patients' survival, urgent improvement of urological care in this field should be considered.

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“…Consistently, Hara et al. 25 had emphasized the usefulness of ECOG score in predicting clinical outcome after radical cystectomy for elderly patients. Moreover, multivariate analysis indicated surgical procedure was independent prognostic factor for PFS in UCB patient.…”

Section: Discussionmentioning

confidence: 99%

Downregulation of miR‐133b predict progression and poor prognosis in patients with urothelial carcinoma of bladder

Chen

et al. 2016

Cancer Medicine

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We found microRNA‐133b (miR‐133b) was downregulated in urothelial carcinoma of the bladder (UCB) tissues, and it could inhibit the proliferation and induce apoptosis in UCB cells. Consequently, we intend to explore the clinical significance of miR‐133b in UCB patients. Expression of miR‐133b in 146 UCB specimens and matched adjacent non‐neoplastic bladder tissues were measured by quantitative real‐time polymerase chain reaction. The overall survival (OS) curve and progression‐free survival (PFS) curve were plotted using the Kaplan–Meier method. Prognostic factors for OS and PFS were identified by univariate and multivariate analyses using the Cox proportional hazards regression model. The expression of miR‐133b was significantly downregulated in UCB tissues compared with those in adjacent non‐neoplastic bladder tissues (P < 0.001). Among UCB patients, low expression of miR‐133b significantly correlated with aggressive clinicopathological features. Multivariate analysis indicated that the expression of miR‐133b was the independent prognostic factors for predicting PFS (RR: 2.97; 95% CI: 1.78–6.44; P = 0.009) and OS (RR: 4.23; 95% CI: 1.51–11.8; P = 0.011) in patients with UCB. Our study demonstrated that downregulation of miR‐133b associated with aggressive clinicopathological features and predicted unfavorable prognosis in patients with UCB, might serve as feasible biomarker for clinical outcome of UCB patients after surgery and potential therapeutic target in the future.

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Use of preoperative performance status and hemoglobin concentration to predict overall survival for patients aged ≥75 years after radical cystectomy for treatment of bladder cancer

Abstract: ECOG PS and preoperative Hb concentration were useful for prediction of clinical outcome after RC for elderly patients. This information may aid decision-making in the treatment of elderly patients with MIBC.

Cited by 28 publications

References 21 publications

Systematic Review of Comorbidity and Competing-risks Assessments for Bladder Cancer Patients

Systematic Review of Comorbidity and Competing-risks Assessments for Bladder Cancer Patients

Predictors and prognostic implications of clinical decisions in patients with primary high-risk non-muscle-invasive bladder cancer – results of a cross country retrospective study

Downregulation of miR‐133b predict progression and poor prognosis in patients with urothelial carcinoma of bladder

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