Michael Froehner1,2, Rainer Koch3, Ulrike Heberling4, Matthias Hübler5, Vladimir Novotny4,6, Angelika Borkowetz4, Manfred P Wirth4, Christian Thomas4. 1. Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstrasse 101, 09130, Chemnitz, Germany. Michael.Froehner@ediacon.de. 2. Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. Michael.Froehner@ediacon.de. 3. Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. 4. Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. 5. Department of Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. 6. Department of Urology, Städtisches Klinikum Görlitz, Girbigsdorfer Strasse 1-3, 02828, Görlitz, Germany.
Abstract
PURPOSE: There is no consensus on the best comorbidity measure in candidates for radical cystectomy. The aim of this study was to identify tool best suited to identify patients at risk for 90-day or premature long-term non-bladder cancer mortality. METHODS: We studied 1268 patients who underwent radical cystectomy to identify patients at risk for 90-day and later-than-90-day mortality, respectively. Six classifications were investigated as possible predictors of both types of mortality. Multivariable models including age as continuous variable and each classification separately were calculated. A heuristic ranking was based on the evaluation of the hazard ratios, p values, Akaike's information criteria, and concerning the logit models also the areas under the curve. RESULTS: The median follow-up was 5.7 years. Within 90 days after surgery, the mortality rate was 4.2%. The greatest independent contribution concerning the prediction of 90-day mortality was seen with the American Society of Anesthesiologists (ASA) physical status classification (classes 3-4 versus 1-2: hazard ratio 7.98, 95% confidence interval 3.54-18.01, p < 0.0001). In the longer term, countable diseases (Canadian Cardiovascular Society classification of angina pectoris, conditions contributing the Charlson score) were of greater importance. The results of heuristic ranking were confirmed by multivariate analyses including age and all classifications together. CONCLUSIONS: Besides to chronological age, clinicians should pay particular attention to the ASA classification to identify patients at risk for 90-day mortality after radical cystectomy, whereas long-term mortality is more determined by countable comorbid diseases.
PURPOSE: There is no consensus on the best comorbidity measure in candidates for radical cystectomy. The aim of this study was to identify tool best suited to identify patients at risk for 90-day or premature long-term non-bladder cancermortality. METHODS: We studied 1268 patients who underwent radical cystectomy to identify patients at risk for 90-day and later-than-90-day mortality, respectively. Six classifications were investigated as possible predictors of both types of mortality. Multivariable models including age as continuous variable and each classification separately were calculated. A heuristic ranking was based on the evaluation of the hazard ratios, p values, Akaike's information criteria, and concerning the logit models also the areas under the curve. RESULTS: The median follow-up was 5.7 years. Within 90 days after surgery, the mortality rate was 4.2%. The greatest independent contribution concerning the prediction of 90-day mortality was seen with the American Society of Anesthesiologists (ASA) physical status classification (classes 3-4 versus 1-2: hazard ratio 7.98, 95% confidence interval 3.54-18.01, p < 0.0001). In the longer term, countable diseases (Canadian Cardiovascular Society classification of angina pectoris, conditions contributing the Charlson score) were of greater importance. The results of heuristic ranking were confirmed by multivariate analyses including age and all classifications together. CONCLUSIONS: Besides to chronological age, clinicians should pay particular attention to the ASA classification to identify patients at risk for 90-day mortality after radical cystectomy, whereas long-term mortality is more determined by countable comorbid diseases.
Authors: Roman Mayr; Mattias May; Thomas Martini; Michele Lodde; Evi Comploj; Armin Pycha; Jenny Strobel; Stefan Denzinger; Wolfgang Otto; Wolfgang Wieland; Maximilian Burger; Hans-Martin Fritsche Journal: Eur Urol Date: 2012-04-12 Impact factor: 20.096
Authors: Atiqullah Aziz; Matthias May; Maximilian Burger; Rein-Jüri Palisaar; Quoc-Dien Trinh; Hans-Martin Fritsche; Michael Rink; Felix Chun; Thomas Martini; Christian Bolenz; Roman Mayr; Armin Pycha; Philipp Nuhn; Christian Stief; Vladimir Novotny; Manfred Wirth; Christian Seitz; Joachim Noldus; Christian Gilfrich; Shahrokh F Shariat; Sabine Brookman-May; Patrick J Bastian; Stefan Denzinger; Michael Gierth; Florian Roghmann Journal: Eur Urol Date: 2013-12-27 Impact factor: 20.096
Authors: Stephen A Boorjian; Simon P Kim; Matthew K Tollefson; Alonso Carrasco; John C Cheville; R Houston Thompson; Prabin Thapa; Igor Frank Journal: J Urol Date: 2013-01-09 Impact factor: 7.450
Authors: Jasmir G Nayak; John L Gore; Sarah K Holt; Jonathan L Wright; Matthew Mossanen; Atreya Dash Journal: Urol Oncol Date: 2015-12-31 Impact factor: 3.498
Authors: Girish S Kulkarni; Antonio Finelli; Neil E Fleshner; Michael A S Jewett; Steven R Lopushinsky; Shabbir M H Alibhai Journal: PLoS Med Date: 2007-09 Impact factor: 11.069