J Schiffmann1, G Gandaglia2, A Larcher2, M Sun3, Z Tian3, S F Shariat4, M McCormack5, L Valiquette5, F Montorsi6, M Graefen7, F Saad5, P I Karakiewicz8. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: schiffmann@martini-klinik.de. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. 4. Department of Urology, Medical University of Vienna, Vienna, Austria. 5. Department of Urology, University of Montreal Health Center, Montreal, Canada. 6. Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy. 7. Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 8. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
Abstract
INTRODUCTION: Existing radical cystectomy (RC) perioperative mortality estimates may underestimate the contemporary rates due to more advanced age, more baseline comorbidities and potentially broader inclusion criteria for RC, relative to past criteria. METHODS: Within the most recent Surveillance, Epidemiology, and End Results (SEER)-Medicare database we identified clinically non-metastatic, muscle-invasive (T2-T4a) urothelial carcinoma of the urinary bladder (UCUB) patients, who underwent RC between 1991 and 2009. Mortality at 30- and 90-day after RC was quantified. Multivariable logistic regression analyses tested predictors of 90-day mortality. RESULTS: Within 5207 assessable RC patients 30- and 90-day mortality rates were 5.2 and 10.6%, respectively. According to age 65-69, 70-79 and ≥ 80 years, 90-day mortality rates were 6.4, 10.1 and 14.8% (p < 0.001). Additionally, 90-day mortality rates increased with increasing Charlson Comorbidity Index (CCI, 0, 1, 2 and ≥ 3): 6.3, 10.3, 12.6 and 15.9% (p < 0.001). 90-day mortality rate in unmarried patients was 13.0 vs. 9.3% in married individuals (p < 0.001). In multivariable logistic regression analyses, advanced age, higher CCI, low socioeconomic status, unmarried status and non organ-confined stage were independent predictors of 90-day mortality (all p < 0.05). CONCLUSIONS: The contemporary SEER-Medicare derived 90-day mortality rates are substantially higher than previously reported estimates from centers of excellence, and even exceed previous SEER reports. More advanced age, higher CCI score, and other patient characteristics that distinguish the current population from others account for these differences.
INTRODUCTION: Existing radical cystectomy (RC) perioperative mortality estimates may underestimate the contemporary rates due to more advanced age, more baseline comorbidities and potentially broader inclusion criteria for RC, relative to past criteria. METHODS: Within the most recent Surveillance, Epidemiology, and End Results (SEER)-Medicare database we identified clinically non-metastatic, muscle-invasive (T2-T4a) urothelial carcinoma of the urinary bladder (UCUB) patients, who underwent RC between 1991 and 2009. Mortality at 30- and 90-day after RC was quantified. Multivariable logistic regression analyses tested predictors of 90-day mortality. RESULTS: Within 5207 assessable RC patients 30- and 90-day mortality rates were 5.2 and 10.6%, respectively. According to age 65-69, 70-79 and ≥ 80 years, 90-day mortality rates were 6.4, 10.1 and 14.8% (p < 0.001). Additionally, 90-day mortality rates increased with increasing Charlson Comorbidity Index (CCI, 0, 1, 2 and ≥ 3): 6.3, 10.3, 12.6 and 15.9% (p < 0.001). 90-day mortality rate in unmarried patients was 13.0 vs. 9.3% in married individuals (p < 0.001). In multivariable logistic regression analyses, advanced age, higher CCI, low socioeconomic status, unmarried status and non organ-confined stage were independent predictors of 90-day mortality (all p < 0.05). CONCLUSIONS: The contemporary SEER-Medicare derived 90-day mortality rates are substantially higher than previously reported estimates from centers of excellence, and even exceed previous SEER reports. More advanced age, higher CCI score, and other patient characteristics that distinguish the current population from others account for these differences.
Authors: Ahmed A Hussein; Kevin J Sexton; Paul R May; Maxwell V Meng; Abolfazl Hosseini; Daniel D Eun; Siamak Daneshmand; Bernard H Bochner; James O Peabody; Ronney Abaza; Eila C Skinner; Richard E Hautmann; Khurshid A Guru Journal: Surg Endosc Date: 2018-04-13 Impact factor: 4.584
Authors: Meera R Chappidi; Max Kates; Hiten D Patel; Jeffrey J Tosoian; Deborah R Kaye; Nikolai A Sopko; Danny Lascano; Jen-Jane Liu; James McKiernan; Trinity J Bivalacqua Journal: Urol Oncol Date: 2016-02-15 Impact factor: 3.498
Authors: Kristen R Scarpato; Stephen F Kappa; Kathryn M Goggins; Sam S Chang; Joseph A Smith; Peter E Clark; David F Penson; Matthew J Resnick; Daniel A Barocas; Kamran Idrees; Sunil Kripalani; Kelvin A Moses Journal: J Health Commun Date: 2016-09-23
Authors: Jeffrey J Leow; Jens Bedke; Karim Chamie; Justin W Collins; Siamak Daneshmand; Petros Grivas; Axel Heidenreich; Edward M Messing; Trevor J Royce; Alexander I Sankin; Mark P Schoenberg; William U Shipley; Arnauld Villers; Jason A Efstathiou; Joaquim Bellmunt; Arnulf Stenzl Journal: World J Urol Date: 2019-01-25 Impact factor: 4.226