BACKGROUND: Patients treated with radical cystectomy represent a very heterogeneous group with respect to cancer-specific and other-cause mortality. Comorbidities and comorbidity-associated events represent very important causes of mortality in those individuals. The authors examined the rates of cancer-specific and other-cause mortality in a population-based radical cystectomy cohort. METHODS: The authors identified 11,260 patients treated with radical cystectomy for urothelial carcinoma of the urinary bladder between 1988 and 2006 within 17 Surveillance, Epidemiology, and End Results registries. Patients were stratified into 20 strata according to patient age and tumor stage at radical cystectomy. Smoothed Poisson regression models were fitted to obtain estimates of cancer-specific and other-cause mortality rates at specific time points after radical cystectomy. RESULTS: After stratification according to disease stage and patient age, cancer-specific mortality emerged as the main cause of mortality in all patient strata. Nonetheless, at 5 years after radical cystectomy, between 8.5% and 27.1% of deaths were attributable to other-cause mortality. The 3 most common causes of other-cause mortality were other malignancies, heart disease, and chronic obstructive pulmonary disease. The most prominent effect on cancer-specific mortality was exerted by locally advanced bladder cancer stages. Conversely, age was the main determinant of other-cause mortality. Interestingly, even after adjusting for bladder cancer pathologic stage, cancer-specific mortality was higher in older individuals than their younger counterparts. CONCLUSIONS: The current study provides a valuable graphical aid for prediction of cancer-specific and other-cause mortality according to disease stage and patient age. It can help clinicians to better stratify the risk-benefit ratio of radical cystectomy. Hopefully, these findings will be considered in treatment decision making and during informed consent before radical cystectomy.
BACKGROUND:Patients treated with radical cystectomy represent a very heterogeneous group with respect to cancer-specific and other-cause mortality. Comorbidities and comorbidity-associated events represent very important causes of mortality in those individuals. The authors examined the rates of cancer-specific and other-cause mortality in a population-based radical cystectomy cohort. METHODS: The authors identified 11,260 patients treated with radical cystectomy for urothelial carcinoma of the urinary bladder between 1988 and 2006 within 17 Surveillance, Epidemiology, and End Results registries. Patients were stratified into 20 strata according to patient age and tumor stage at radical cystectomy. Smoothed Poisson regression models were fitted to obtain estimates of cancer-specific and other-cause mortality rates at specific time points after radical cystectomy. RESULTS: After stratification according to disease stage and patient age, cancer-specific mortality emerged as the main cause of mortality in all patient strata. Nonetheless, at 5 years after radical cystectomy, between 8.5% and 27.1% of deaths were attributable to other-cause mortality. The 3 most common causes of other-cause mortality were other malignancies, heart disease, and chronic obstructive pulmonary disease. The most prominent effect on cancer-specific mortality was exerted by locally advanced bladder cancer stages. Conversely, age was the main determinant of other-cause mortality. Interestingly, even after adjusting for bladder cancer pathologic stage, cancer-specific mortality was higher in older individuals than their younger counterparts. CONCLUSIONS: The current study provides a valuable graphical aid for prediction of cancer-specific and other-cause mortality according to disease stage and patient age. It can help clinicians to better stratify the risk-benefit ratio of radical cystectomy. Hopefully, these findings will be considered in treatment decision making and during informed consent before radical cystectomy.
Authors: Ettore Di Trapani; Rafael Sanchez-Salas; Giorgio Gandaglia; Lorenzo Rocchini; Marco Moschini; Daphne Lizee; Arie Carneiro; Arjun Sivaraman; Eric Barret; François Rozet; Marc Galiano; Mostefa Bennamoun; Renzo Colombo; Nazareno Suardi; Alberto Briganti; Francesco Montorsi; Xavier Cathelineau Journal: World J Urol Date: 2015-07-22 Impact factor: 4.226
Authors: M May; H-M Fritsche; C Gilfrich; S Brookman-May; M Burger; W Otto; C Bolenz; L Trojan; E Herrmann; M S Michel; C Wülfing; A Tiemann; S C Müller; J Ellinger; A Buchner; C G Stief; D Tilki; W F Wieland; T Höfner; M Hohenfellner; A Haferkamp; J Roigas; O Müller; P Bretschneider-Ehrenberg; M Zacharias; S Gunia; P J Bastian Journal: Urologe A Date: 2011-07 Impact factor: 0.639
Authors: M May; M Burger; S Brookman-May; W Otto; J Peter; O Rud; H-M Fritsche; C Bolenz; L Trojan; E Herrmann; M S Michel; C Wülfing; R Moritz; A Tiemann; S C Müller; J Ellinger; A Buchner; C G Stief; D Tilki; W F Wieland; C Gilfrich; T Höfner; M Hohenfellner; A Haferkamp; J Roigas; P Bretschneider-Ehrenberg; O Müller; M Zacharias; S Gunia; P J Bastian Journal: Urologe A Date: 2011-06 Impact factor: 0.639
Authors: Alexander Kutikov; Brian L Egleston; Daniel Canter; Marc C Smaldone; Yu-Ning Wong; Robert G Uzzo Journal: J Urol Date: 2012-10-18 Impact factor: 7.450
Authors: Stephen B Williams; Ashish M Kamat; Karim Chamie; Michael Froehner; Manfred P Wirth; Peter N Wiklund; Peter C Black; Gary D Steinberg; Stephen A Boorjian; Sia Daneshmand; Peter J Goebell; Kamal S Pohar; Shahrokh F Shariat; George N Thalmann Journal: Eur Urol Oncol Date: 2018-06-06
Authors: Ashkan Mortezavi; Alessio Crippa; Sebastian Edeling; Sasa Pokupic; Paolo Dell'Oglio; Francesco Montorsi; Frederiek D'Hondt; Alexandre Mottrie; Karel Decaestecker; Carl J Wijburg; Justin Collins; John D Kelly; Wei Shen Tan; Ashwin Sridhar; Hubert John; Abdullah Erdem Canda; Christian Schwentner; Erik Peder Rönmark; Peter Wiklund; Abolfazl Hosseini Journal: BJU Int Date: 2020-11-05 Impact factor: 5.588