Age above 70 years and Charlson Comorbidity Index higher than 3 are associated with reduced survival probabilities after radical cystectomy for bladder cancer. Data from a contemporary series of 334 consecutive patients

Objective: To assess the joint effect of age and comorbidities on clinical outcomes of radical cystectomy (RC).Methods: 334 consecutive patients undergoing open RC for bladder cancer (BC) during the years 2005-2015 were analyzed. Pre-, peri- and post-operative parameters, including age at RC (ARC) and Charlson Comorbidity Index (CCI), were evaluated. Overall and cancer-specific survivals (OS, CSS) were assessed by univariate and multivariate modelling. Furthermore, a three-knot restricted cubic spline (RCS) was fitted to survival data to detect dependency between death-rate ratio (HR) and ARC. Results: Median follow-up time was 3.8 years (IQR = 1.3-7.5) while median OS was 5.9 years (95%CL = 3.8-9.1). Globally, 180 patients died in our cohort (53.8%), 112 of which (62.2%) from BC and 68 patients (37.8%) for unrelated causes. After adjusting for preoperative, pathological and perioperative parameters, patients with CCI > 3 showed significantly higher death rates (HR = 1.61; p = 0.022). The highest death rate was recorded in ARC = 71-76 years (HR = 2.25; p = 0.034). After fitting an RCS to both OS and CSS rates, two overlapping nonlinear trends, with common highest risk values included in ARC = 70-75 years, were observed. Conclusions: Age over 70 years and CCI > 3 were significant factors limiting the survival of RC and should both be considered when comparing current RC outcomes.

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The impact of patient-related nonmodifiable factors on perioperative outcomes following radical cystectomy with enhanced recovery protocol

Therapeutic Advances in Urology ◽

10.1177/1756287218811019 ◽

2018 ◽

Vol 10 (12) ◽

pp. 393-401 ◽

Cited By ~ 4

Author(s):

Daniel Zainfeld ◽

Jian Chen ◽

Jie Cai ◽

Gus Miranda ◽

Anne Schuckman ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Charlson Comorbidity Index ◽

Enhanced Recovery ◽

Perioperative Outcomes ◽

Patient Counseling ◽

Comorbidity Index ◽

Index 2 ◽

Eras Protocol ◽

The Impact

Background: Enhanced recovery after surgery (ERAS) protocols decrease the length of hospital stay (LOS) and complications following radical cystectomy (RC). However, the impact of non-modifiable patient factors to postoperative outcome is unclear. This study aimed to identify nonmodifiable patient and disease factors predictive of post-RC outcomes with ERAS protocols. Methods: We reviewed our institutional review board-approved prospectively maintained bladder cancer database. Patients with primary urothelial bladder cancer who underwent open RC with ERAS protocol between 2012 and 2016 were identified. Patient demographic and disease-relevant variables were reviewed. Factors predictive of LOS, 30- and 90-day complications and readmission were assessed using univariate and multivariable analyses. Results: A total of 289 patients with a median age of 70 years were included, of whom 80.6% were male, 33.6% had Charlson comorbidity index ⩾2. Median LOS was 4 days and 21.1% received intraoperative transfusion. The 30-day complication and readmission rates were 58.8% and 16.6%, respectively. Age >70 ( p = 0.02), Charlson comorbidity index ⩾2 ( p = 0.005), and intraoperative transfusion ( p = 0.03) were significantly associated with LOS. Intraoperative transfusion was significantly associated with 30-day complication and readmission ( p = 0.008, p = 0.005, respectively). No factor was found to be significantly associated with 90-day complication or readmission. Conclusions: With ERAS protocol, non-modifiable patient and disease factors influence outcomes after RC. Risk adjustment for these factors is important for patient counseling, quality assessment and future reimbursement.

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A comparison of Charlson comorbidity index and cardiopulmonary exercise testing in predicting outcomes after Robotic Assisted Radical Cystectomy (RARC) and intracorporeal reconstruction for bladder cancer

European Urology ◽

10.1016/s0302-2838(21)01181-7 ◽

2021 ◽

Vol 79 ◽

pp. S1114

Author(s):

A. McPhee ◽

A. Ridgway ◽

T. Bird ◽

E. Rowe ◽

A. Koupparis ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Exercise Testing ◽

Charlson Comorbidity Index ◽

Cardiopulmonary Exercise Testing ◽

Robotic Assisted ◽

Cardiopulmonary Exercise ◽

Comorbidity Index

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The impending need of a new disease specific comorbidity index for bladder cancer patients candidate to robot-assisted radical cystectomy

European Urology Supplements ◽

10.1016/s1569-9056(19)30950-9 ◽

2019 ◽

Vol 18 (1) ◽

pp. e1316

Author(s):

E. Lambert ◽

P. Dell’Oglio ◽

J. Vollemaere ◽

P. Uvin ◽

M. Goossens ◽

...

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Radical Cystectomy ◽

New Disease ◽

Robot Assisted ◽

Comorbidity Index ◽

Disease Specific

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509 Simplified Charlson Comorbidity Index for assessment of perioperative mortality after radical cystectomy

European Urology Supplements ◽

10.1016/s1569-9056(16)60511-0 ◽

2016 ◽

Vol 15 (3) ◽

pp. e509

Author(s):

P. Dell'Oglio ◽

Z. Tian ◽

S-R. Leyh-Bannurah ◽

A. Larcher ◽

M. Moschini ◽

...

Keyword(s):

Radical Cystectomy ◽

Charlson Comorbidity Index ◽

Perioperative Mortality ◽

Comorbidity Index

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Survival outcomes comparable between endoscopic resection and surgical resection for T1b esophageal adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.100 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 100-100

Author(s):

Samit Kumar Datta ◽

Geoffrey Belini ◽

Maharaj Singh ◽

Wesley Allan Papenfuss ◽

Lyndon Hernandez ◽

...

Keyword(s):

Esophageal Cancer ◽

Surgical Resection ◽

Endoscopic Resection ◽

Charlson Comorbidity Index ◽

National Database ◽

Mortality Data ◽

Survival Outcomes ◽

Cancer Data ◽

Comorbidity Index ◽

Large National Database

100 Background: Current guidelines recommend esophagectomy for submucosal T1b esophageal cancer. Data regarding efficacy of endoscopic resection (ER) of T1b esophageal cancer are limited. Our goal was to compare survival outcomes of ER as opposed to conventional surgical resection (SR) in a large cohort of patients with T1b cancers from a large national database. Methods: Data were obtained from the large national database maintained by the Commission on Cancer. Patients with T1b esophageal cancers with clinical stage 1A and 1B who underwent ER and SR between 2010 and 2014 were identified using the American Joint Committee on Cancer (AJCC Version 7). Patients undergoing ER and SR were identified. Patients who underwent neoadjuvant therapy or had incomplete survival data were excluded. The primary outcome was survival for age and Deyo-Charlson comorbidity index. We also evaluated 30-Day and 90-Day Mortality outcomes. Results: There were 1071 patients with T1b esophageal cancer with complete mortality data. After selecting and excluding patients above, 141 patients were identified who underwent EET and 286 who underwent esophagectomy. Average age was 71.5 years in the ER group and 64.5 years in the SR group (p < 0.001). In the group, 30-Day mortality after surgery was 1/134 (0.8%, 7 missing) compared to surgery with 30-Day mortality of 6/283 (2.1%, 3 missing) (P = 0.308). 90-Day mortality after surgery for the ER group was 3/134 (2.2%, 7 missing) compared with the surgery with 90-Day mortality of 11/281 (3.9%, 5 missing) (P = 0.377). Adjusted for age and Deyo-Charlson comorbidity index, there was a HR of 1.051 (95% CI 0.695-1.589, p = 0.815) for mortality associated with surgery compared with ER. Mean follow-up of 42.6 months for the ER group and 55.7 months for surgery group. Conclusions: Based on the data from a large national cancer data base ER seems to be comparable to SR in terms of short term (30 day and 90 day) mortality. Overall survival seems to be similar in both groups Prospectively done randomized studies comparing ER versus SR are desirable.

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