Ugo Fedeli1, Angela De Paoli1, Maria Chiara Corti1, Giovanni Enrico Cacciamani2,3, Inderbir S Gill3, Filiberto Zattoni4, Giacomo Novara4, Angelo Porreca5, Walter Artibani6. 1. Epidemiological Department, Azienda Zero, Padova, Italy. 2. Department of Urology, University of Verona, Verona, Italy. 3. USC Institute of Urology and the Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California, USA. 4. Urologic Unit, Department of Oncologic, Surgical and Gastrointestinal Sciences, University of Padua, Padua, Italy. 5. Department of Urology, Policlinico Abano Terme, Abano Terme, Italy. 6. Department of Urology, University of Verona, Verona, Italy, walter.artibani@univr.it.
Abstract
PURPOSE: Population-based data on survival after radical cystectomy (RC) are lacking from Southern Europe. The aim of this study was to assess trends and determinants of perioperative mortality and long-term survival in the Veneto region (Northeastern Italy). METHODS: All patients submitted to RC for bladder cancer from January 2004 to December 2016 were identified from the regional archive of hospital discharge records. Age at surgery, gender, comorbidities, hospital volume, calendar period of surgery, and type of urinary diversion were retrieved; vital status and cause of death were obtained by linkage with mortality records. Determinants of 90-day mortality were assessed by multilevel logistic regression; long-term survival was investigated by the Kaplan-Meier method and Cox regression. RESULTS: Among 4,389 included patients, an increase in the share of patients aged ≥80 years (from 13% in 2004-2008 to 24% in 2013-2016, p < 0.001) and a decline in performing continent diversion (from 34.9 to 23.4%, p < 0.001) were observed across the study period. Ninety-day mortality did not change over time and was 4% for patients aged <70 years and 13.7% for those aged ≥80 years. Age- and comorbidities-adjusted mortality was significantly lower in hospitals performing >30 RCs/year (odds ratio 0.67, 95% confidence interval 0.48-0.93). At a median follow-up of 67 months, overall survival at 1 year and 5 years was 72 and 40%, respectively, with a higher rate among younger patients treated in high-volume hospitals. CONCLUSION: The population of patients treated with RC is rapidly ageing, with a high risk of perioperative and long-term mortality; this changing epidemiological scenario and better outcomes observed in high-volume hospitals support regionalization of the procedure.
PURPOSE: Population-based data on survival after radical cystectomy (RC) are lacking from Southern Europe. The aim of this study was to assess trends and determinants of perioperative mortality and long-term survival in the Veneto region (Northeastern Italy). METHODS: All patients submitted to RC for bladder cancer from January 2004 to December 2016 were identified from the regional archive of hospital discharge records. Age at surgery, gender, comorbidities, hospital volume, calendar period of surgery, and type of urinary diversion were retrieved; vital status and cause of death were obtained by linkage with mortality records. Determinants of 90-day mortality were assessed by multilevel logistic regression; long-term survival was investigated by the Kaplan-Meier method and Cox regression. RESULTS: Among 4,389 included patients, an increase in the share of patients aged ≥80 years (from 13% in 2004-2008 to 24% in 2013-2016, p < 0.001) and a decline in performing continent diversion (from 34.9 to 23.4%, p < 0.001) were observed across the study period. Ninety-day mortality did not change over time and was 4% for patients aged <70 years and 13.7% for those aged ≥80 years. Age- and comorbidities-adjusted mortality was significantly lower in hospitals performing >30 RCs/year (odds ratio 0.67, 95% confidence interval 0.48-0.93). At a median follow-up of 67 months, overall survival at 1 year and 5 years was 72 and 40%, respectively, with a higher rate among younger patients treated in high-volume hospitals. CONCLUSION: The population of patients treated with RC is rapidly ageing, with a high risk of perioperative and long-term mortality; this changing epidemiological scenario and better outcomes observed in high-volume hospitals support regionalization of the procedure.
Authors: Angelo Porreca; Katie Palmer; Walter Artibani; Alessandro Antonelli; Lorenzo Bianchi; Eugenio Brunocilla; Aldo Massimo Bocciardi; Maurizio Brausi; Gian Maria Busetto; Marco Carini; Giuseppe Carrieri; Antonio Celia; Luca Cindolo; Giovanni Cochetti; Renzo Colombo; Ettore De Berardinis; Ottavio De Cobelli; Fabrizio Di Maida; Amelio Ercolino; Franco Gaboardi; Antonio Galfano; Andrea Gallina; Michele Gallucci; Carlo Introini; Ettore Mearini; Andrea Minervini; Francesco Montorsi; Gennaro Musi; Giovannalberto Pini; Riccardo Schiavina; Silvia Secco; Sergio Serni; Claudio Simeone; Giovanni Tasso; Daniele D'Agostino Journal: BMC Cancer Date: 2021-01-11 Impact factor: 4.430