Perioperative blood transfusion and postoperative outcomes in patients undergoing radical cystectomy for bladder cancer.

e17012 Background: Perioperative blood transfusion (PBT) has been associated with worse outcomes in surgical oncology across tumor types. We report our institutional experience of postoperative outcomes related to PBT utilization, in patients (pts) with bladder cancer (BC) treated with radical cystectomy (RC). We hypothesized that PBT is associated with worse clinical outcomes. Methods: Pts with BC treated with RC were retrospectively identified. Clinicopathologic and peri/post-operative data were extracted. PBT was defined as red blood cell transfusion during RC or postoperative hospitalization. Overall survival (OS, diagnosis to death) and recurrence free survival (RFS, RC to recurrence/death) were estimated with the KM method. T-test, χ2 and log-rank test were used for group comparison analysis. Univariate/multivariate logistic (LR) and Cox regression (CR) were used to identify variables associated with dependent dichotomous outcomes and OS/RFS, respectively. Results: 784 consecutive pts (78% men; median age 67) were identified. At least one post-operative complication (POC) occurred in 407 (52%) pts; most common were pyelonephritis and sepsis (11% each). PBT was administered to 238 pts (30%). Those with PBT had a higher proportion of POCs (35% vs 28%, p = .02). Median follow-up, OS and RFS were 66 (95% CI: 60 - 72), 94 (95% CI: 79 - 109) and 66 months (95% CI: 50 – 82), respectively. Pts who received PBT had shorter OS (51 vs 130 months, p < .001) and RFS (27 vs 86 months, p < .001). In multivariate LR and CR, PBT was independently associated with higher odds of POCs (OR 1.5, 95% CI: 1.03 – 2.2, p = .03), length of hospital stay (LOS) > 10 days (OR 2.0, 95% CI 1.1 – 3.5, p = .02), shorter OS (HR 1.6, 95% CI 1.2-2.0, p = .001), and RFS (HR 1.5, 95% CI 1.2 - 1.9, p = .001), after adjustment for other relevant clinicopathologic variables (age, gender, performance status, neoadjuvant chemotherapy, baseline hemoglobin, open/robotic approach, pT/N stage, surgical margins, lymphovascular invasion at RC, variant histologies). Conclusions: Pts who received PBT had higher odds of POC, longer LOS and poor outcomes after RC. This is hypothesis-generating due to inherent study limitations. Further studies are needed to validate this finding, explain underlying mechanisms and explore putative interventions to improve outcomes.

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Association of metabolic equivalent of task (MET) score in length of stay in hospital following radical cystectomy with urinary diversion: a multi-institutional study

International Urology and Nephrology ◽

10.1007/s11255-021-02813-x ◽

2021 ◽

Author(s):

Chun Shea ◽

Abdul Rouf Khawaja ◽

Khalid Sofi ◽

Ghulam Nabi

Keyword(s):

Hospital Stay ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Functional Capacity ◽

Cox Regression ◽

Length Of Hospital Stay ◽

Postoperative Outcomes ◽

Comorbid Conditions ◽

Metabolic Equivalent ◽

Metabolic Equivalent Of Task

Abstract Purpose The Metabolic equivalent of task (MET) score is used in patients’ preoperative functional capacity assessment. It is commonly thought that patients with a higher MET score will have better postoperative outcomes than patients with a lower MET score. However, such a link remains the subject of debate and is yet unvalidated in major urological surgery. This study aimed to explore the association of patients’ MET score with their postoperative outcomes following radical cystectomy. Methods We used records-linkage methodology with unique identifiers (Community Health Index/hospital number) and electronic databases to assess postoperative outcomes of patients who had underwent radical cystectomies between 2015 and 2020. The outcome measure was patients’ length of hospital stay. This was compared with multiple basic characteristics such as age, sex, MET score and comorbid conditions. A MET score of less than four (< 4) is taken as the threshold for a poor functional capacity. We conducted unadjusted and adjusted Cox regression analyses for time to discharge against MET score. Results A total of 126 patients were included in the analysis. Mean age on date of operation was 66.2 (SD 12.2) years and 49 (38.9%) were female. A lower MET score was associated with a statistically significant lower time-dependent risk of hospital discharge (i.e. longer hospital stay) when adjusted for covariates (HR 0.224; 95% CI 0.077–0.652; p = 0.006). Older age (adjusted HR 0.531; 95% CI 0.332–0.848; p = 0.008) and postoperative complications (adjusted HR 0.503; 95% CI 0.323–0.848; p = 0.002) were also found to be associated with longer hospital stay. Other comorbid conditions, BMI, disease staging and 30-day all-cause mortality were statistically insignificant. Conclusion A lower MET score in this cohort of patients was associated with a longer hospital stay length following radical cystectomy with urinary diversion.

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Myosteatosis as a novel prognostic biomarker after radical cystectomy for bladder cancer

Scientific Reports ◽

10.1038/s41598-020-79340-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Shimpei Yamashita ◽

Yuya Iwahashi ◽

Haruka Miyai ◽

Takashi Iguchi ◽

Hiroyuki Koike ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Cox Regression ◽

Group Performance ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Psoas Muscle ◽

Hounsfield Units ◽

Computed Tomography Images ◽

Psoas Muscles

AbstractThis study aims to evaluate the influence of myosteatosis on survival of patients after radical cystectomy (RC) for bladder cancer. We retrospectively identified 230 patients who underwent RC for bladder cancer at our three institutions between 2009 and 2018. Digitized free-hand outlines of the left and right psoas muscles were made on axial non-contrast computed tomography images at level L3. To assess myosteatosis, average total psoas density (ATPD) in Hounsfield Units (HU) was also calculated as an average of bilateral psoas muscle density. We compared cancer-specific survival (CSS) between high ATPD and low ATPD groups and performed cox regression hazard analyses to identify the predictors of CSS. Median ATPD was 44 HU (quartile: 39–47 Hounsfield Units). Two-year CSS rate in overall patients was 76.6%. Patients with low ATPD (< 44 HU) had significantly lower CSS rate (P = 0.01) than patients with high ATPD (≥ 44 HU). According to multivariate analysis, significant independent predictors of poor CSS were: Eastern Cooperative Oncology Group performance status ≥ 1 (P = 0.03), decreasing ATPD (P = 0.03), non-urothelial carcinoma (P = 0.01), pT ≥ 3 (P < 0.01), and pN positive (P < 0.01). In conclusion, myosteatosis (low ATPD) could be a novel predictor of prognosis after RC for bladder cancer.

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Perioperative Blood Transfusion and Radical Cystectomy: Does Timing of Transfusion Affect Bladder Cancer Mortality?

European Urology ◽

10.1016/j.eururo.2014.08.051 ◽

2014 ◽

Vol 66 (6) ◽

pp. 1139-1147 ◽

Cited By ~ 42

Author(s):

E. Jason Abel ◽

Brian J. Linder ◽

Tyler M. Bauman ◽

Rebecca M. Bauer ◽

R. Houston Thompson ◽

...

Keyword(s):

Bladder Cancer ◽

Blood Transfusion ◽

Radical Cystectomy ◽

Cancer Mortality ◽

Perioperative Blood Transfusion

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Survival Outcomes in Stage IV Bladder Cancer Patients Treated with Cisplatin/Gemcitabine Versus Carboplatin/Gemcitabine: A Retrospective Analysis in Veteran Patients

Clinical Oncology and Research ◽

10.31487/j.cor.2020.06.02 ◽

2020 ◽

pp. 1-4

Author(s):

Anuradha Kunthur ◽

Eric Siegel ◽

Rangaswamy Govindarajan

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Cox Regression ◽

Performance Status ◽

Stage Iv ◽

Rank Test ◽

Poor Performance Status ◽

Health Administration ◽

Standard Regimen ◽

Urothelial Bladder

Purpose: Gemcitabine/cisplatin (GCi) is the standard regimen used to treat stage IV urothelial bladder cancers. However, most of the bladder cancer patients are older, with poor performance status and renal dysfunction, and are not eligible for cisplatin-containing regimens. There are no randomized studies comparing gemcitabine/carboplatin (GC) and gemcitabine/cisplatin (GCi). Methods: We identified stage IV bladder cancer patients treated within the Veterans Health Administration (VHA), healthcare system between January 2000 and December 2010 from Veterans Affairs Central Cancer Registry (VACCR). Overall survival (OS) was visualized using Kaplan-Meier curves and tested for the significance of the treatment-arm difference using the log-rank test. Results: There were 196 patients with stage IV bladder cancer, out of which 78 patients were treated with GC and 118 patients treated with GCi. The median OS for all patients was 12.5 months a 95% confidence interval (CI) of 10.0-14.6 months. The median OS for patients treated with GC was 13.4 months (95% CI 9.8-17.5 months), and that of the patients treated with GCi was 11.7 months (95% CI 9.3-14.9 months). Cox regression revealed equal group mortality rates, with GC having a (hazard ratio (HR) of 0.96 (CI 0.72-1.27; P= 0.81)) compared to GCi. Conclusion: Our study is the largest comparing GC and GCi in stage IV urothelial bladder cancer patients. It showed that there is no difference in OS in patients treated with GC and GCi.

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Predicting survival after radical cystectomy: Validation of the SPARC score.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.326 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 326-326

Author(s):

Brian Robin Hu ◽

Manuel S Eisenberg ◽

Stephen A. Boorjian ◽

Igor Frank ◽

Leo Dalag ◽

...

Keyword(s):

Bladder Cancer ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Smoking Status ◽

Performance Status ◽

Rank Test ◽

Survival Prediction ◽

Kaplan Meier ◽

Pathologic Features ◽

Carcinoma Of The Bladder

326 Background: The Survival Prediction After Radical Cystectomy (SPARC) score (Eisenberg et al, J Urol 2013) incorporates clinical and pathologic features to predict cancer specific survival (CSS) for urothelial carcinoma of the bladder. Validation of this model would improve its generalizability. Methods: Using the IRB-approved bladder cancer database at the University of Southern California (USC), we identified patients who underwent radical cystectomy (RC) for urothelial carcinoma of the bladder for curative intent from 1971-2009. Clinical factors (Charlson comorbidity index, ECOG performance status, hydronephrosis, adjuvant chemotherapy, smoking status) and pathologic factors (pathologic T stage, nodal status, multifocality, and lymphovascular invasion) included in the SPARC score were obtained. Patients were excluded if there were missing variables or if they underwent neoadjuvant chemotherapy. Associations between clinicopathologic factors and CSS were evaluated using Cox proportional hazards. Calibration plots were generated comparing actuarial CSS with SPARC predicted CSS by deciles. A c-index was generated to determine accuracy of the prediction. Kaplan Meier curves estimated CSS stratified by SPARC score and were compared with the log rank test. Results: A total of 2,045 patients underwent RC and 1,123 (55%) met inclusion criteria with a median follow-up of 4.7 years (IQR 2.0-8.9 years). Of the 1,123 patients, 332 (30%) died of bladder cancer. All the clinical and pathologic variables used in the SPARC scoring model were associated with CSS except for smoking status and tumor multifocality. Calibration plots demonstrated concordance between the SPARC-predicted and actuarial CSS with a c-index of 0.75. Kaplan Meier curves demonstrated significant differences in CSS based upon SPARC score, p<0.001. Conclusions: The SPARC score represents a valid instrument for predicting bladder CSS after RC. The model can be utilized to better tailor adjuvant therapy and surveillance.

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The Impact of Perioperative Blood Transfusion on Survival of Bladder Cancer Patients Submitted to Radical Cystectomy: Role of Anemia Status

European Urology Focus ◽

10.1016/j.euf.2015.03.002 ◽

2016 ◽

Vol 2 (1) ◽

pp. 86-91 ◽

Cited By ~ 9

Author(s):

Marco Moschini ◽

Marco Bianchi ◽

Giorgio Gandaglia ◽

Vito Cucchiara ◽

Stefano Luzzago ◽

...

Keyword(s):

Bladder Cancer ◽

Blood Transfusion ◽

Cancer Patients ◽

Radical Cystectomy ◽

The Impact ◽

Perioperative Blood Transfusion

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Association of positive Ki-67 and PD-L1 expressions in post neoadjvuant chemotherapy (NAC) radical cystectomy samples with lack of tumor downstaging (TD) and shorter overall survival (OS) in patients with muscle-invasive bladder cancer (MIBC).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.554 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 554-554

Author(s):

Selene Rubino ◽

Wade J. Sexton ◽

Youngchul Kim ◽

Junmin Zhou ◽

Jasreman Dhilon ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Cox Regression ◽

Unmet Need ◽

Predictive Biomarker ◽

Complete Response ◽

Tissue Microarrays ◽

Rank Test ◽

Cancer Center ◽

Ki 67

554 Background: Previous chart review studies have reported that adjuvant chemotherapy after NAC did not clearly increase OS in MIBC cases characterized by a lack of TD. There is an unmet need to develop biomarkers to guide adjuvant therapy for this patient population. High levels of expression of cell proliferation marker Ki-67 are associated with poor outcome in chemotherapy naïve bladder cancer. Expression of PD-L1 has been studied as a potential predictive biomarker for anti-PD1 or PD-L1 therapies in metastatic MIBC. We therefore studied Ki-67 and PD-L1 expression in post NAC radical cystectomy samples at Moffitt Cancer Center and correlate them with TD and OS. Methods: Tissue microarrays (TMAs) were constructed from 116 post NAC cystectomy samples. The expressions of Ki-67 were evaluated with immunohistochemistry (IHC) and considered positive if any of the cores per sample were stained positive for Ki-67. The Dako 22C3 assay was used for PD-L1 IHC and the combined positive score of 10 or above was considered positive for PD-L1. Results: The median survival of this cohort of 116 patients was 33.4 months (range: 1.13 -127 months). 40 patients (35%) had TD and 21 patients (18%) achieved pathological complete response. Using Cox regression for OS, positive Ki-67 expression in post NAC radical cystectomy sample was associated with poorer OS (hazard ratio=2.412, 95% CI:1.076-5.408, p=0.033), independent of the pathological N stage. Patients with Ki67/PD-L1 double-negative tumors had a significantly longer median OS of 98.2 months versus 29.9 and 26.9 months in PD-L1-/Ki67+ and PD-L1+/Ki67+ tumors respectively (Log-rank test, p=0.0361). Lack of TD was significantly associated with positive Ki-67 (P<0.001) and positive PD-L1 (p=0.003) in the post NAC samples with a multi-variable logistic regression model. Conclusions: Positive Ki-67 and PD-L1 expressions in post NAC radical cystectomy samples were associated with inferior OS and absence of TD. Adjuvant anti-PD1 therapy either alone or in combination with chemotherapy would be indicated for this subset of patients.

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