Mayr, Roman and May, Mattias and Martini, Thomas and Lodde, Michele and Comploj, Evi and Pycha, Armin and Strobel, Jenny and Denzinger, Stefan and Otto, Wolfgang and Wieland, Wolfgang and Burger, Maximilian and Fritsche, Hans-Martin (2012) Comorbidity and Performance Indices as Predictors of Cancer-Independent Mortality But Not of Cancer-Specific Mortality After Radical Cystectomy for Urothelial Carcinoma of the Bladder. EUROPEAN UROLOGY, 62 (4). pp. 662-670. ISSN 0302-2838,
Full text not available from this repository. (Request a copy)Abstract
Background: Comorbidity and performance indices allow assessment of preoperative health status. However, the optimal tool for use in patients with urothelial carcinoma of the bladder (UCB) who are undergoing radical cystectomy (RC) has not yet been established. Objective: To evaluate correlation of Adult Comorbidity Evaluation-27 (ACE27), Charlson Comorbidity Index, Age-Adjusted Charlson Comorbidity Index, Eastern Cooperative Oncology Group performance status, and American Society of Anesthesiologists (ASA) score with survival. Design, setting, and participants: A retrospective multicenter study was carried out on 555 unselected consecutive patients who underwent RC for UCB from 2000 to 2010. Intervention: RC with pelvic lymph node dissection in patients with UCB without neoadjuvant chemotherapy. Outcome measurements and statistical analysis: Cox regression models were calculated with established variables to assess predictive capacity for cancer-specific mortality (CSM) and cancer-independent mortality (CIM). Results and limitations: All indices were independent predictors for CIM but not for CSM. The ASA score was the only index that significantly increased the predictive accuracy of the predefined CIM model (+2.3%; p = 0.045). To create a clinically valuable tool, we devised a weighted prognostic model including age and the best prognosticators within the performance and comorbidity scores (ASA/ACE27 0-1/2-3). A 3-yr CIM rate of 8%, 26%, and 47% was calculated for the low-, intermediate-, and high-risk groups, respectively. Patients >75 yr of age with ASA 3/4 and ACE27 >1 exhibited a CIM risk seven times greater than patients <= 75 yr with ASA 1/2 and ACE27 0/1. This study is limited by the short follow-up and its retrospective nature. Conclusions: Comorbidity and performance assessment is mandatory in the preoperative prediction of CIM for patients undergoing RC for UCB. The present results indicate that the ASA score is the tool of choice. External and prospective validation is warranted. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CLINICAL-OUTCOMES; COMPETING RISK; SURVIVAL; MORBIDITY; IMPACT; MUSCLE; THERAPY; SCORE; AGE; Comorbidity; Cystectomy; ACE27; CCI; ACCI; ASA; ECOG; Urothelial carcinoma; Bladder cancer; Cancer-independent mortality |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 06 May 2020 04:58 |
| Last Modified: | 06 May 2020 04:58 |
| URI: | https://pred.uni-regensburg.de/id/eprint/18070 |
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