Shang Huang1, Hanzhong Chen1, Teng Li1, Xiaoyong Pu1, Jiumin Liu1, Xuecheng Bi2. 1. Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China. 2. Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China. doctorbi1975@163.com.
Abstract
BACKGROUND: In bladder cancer patients with age ≥ 80 years old, there have been controversies in performing uretero-cutaneostomy or ileal conduit as urinary diversion after radical cystectomy. Limited study evaluated overall survival (OS) and cancer-specific survival (CSS) between the two urinary diversions in elderly patients. This study is to compare OS and CSS between uretero-cutaneostomy and ileal conduit after radical cystectomy in bladder cancer patients with age ≥ 80 years old. PATIENTS AND METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Bladder cancer patients diagnosed between 2004 and 2016 with age ≥ 80 years old who underwent radical cystectomy with either UC or IC were selected. After propensity score matching, Cox regression and Kaplan-Meier analysis were used to analyze the survival. We calculated statistical power for survival. RESULTS: Of 1394 patients who met the inclusion criteria, 1093 underwent ileal conduit and 301 underwent uretero-cutaneostomy. After propensity score matching, 285 patients were included in each group. Multivariable Cox analysis showed urinary diversion was not a risk factor of OS and CSS (HR 1.044, [95% CI 0.867-1.257] and 1.012 [0.748-1.368], respectively). Both OS and CSS were not significantly different, with median survival of ileal conduit and uretero-cutaneostomy were 19 [16-24] months and 19 [15-26] months respectively. Additionally, We found OS had the following risk factors: tumor stage (distant vs regional vs localized, 5.332 [3.610-7.875] vs 1.730 [1.375-2.176] vs 1), node density (>0.2 vs ≤0.2 vs none, 1.410 [1.047-1.898] vs 0.941 [0.658-1.344] vs 1) and age (1.067 [1.032-1.103] for each year). While CSS had the following risk factors: tumor stage (distant vs regional vs localized, 4.035 [2.046-7.959] vs 2.476 [1.651-3.713] vs 1), node density (>0.2 vs ≤0.2 vs none, 2.501 [1.645-3.804] vs 1.062 [0.590-1.914] vs 1) and tumor size (greater than 3 cm vs less than 3 cm, 1.596 [1.057-2.412] vs 1). Our analysis obtained 0.707 power for overall survival. CONCLUSION: Urinary diversion by uretero-cutaneostomy or by ileal conduit was not associated with overall and cancer-specific survival. It is reasonable to consider uretero-cutaneostomy as a regular procedure of urinary diversion in elderly bladder cancer patients after radical cystectomy to avoid associate complications.
BACKGROUND: In bladder cancerpatients with age ≥ 80 years old, there have been controversies in performing uretero-cutaneostomy or ileal conduit as urinary diversion after radical cystectomy. Limited study evaluated overall survival (OS) and cancer-specific survival (CSS) between the two urinary diversions in elderly patients. This study is to compare OS and CSS between uretero-cutaneostomy and ileal conduit after radical cystectomy in bladder cancerpatients with age ≥ 80 years old. PATIENTS AND METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Bladder cancerpatients diagnosed between 2004 and 2016 with age ≥ 80 years old who underwent radical cystectomy with either UC or IC were selected. After propensity score matching, Cox regression and Kaplan-Meier analysis were used to analyze the survival. We calculated statistical power for survival. RESULTS: Of 1394 patients who met the inclusion criteria, 1093 underwent ileal conduit and 301 underwent uretero-cutaneostomy. After propensity score matching, 285 patients were included in each group. Multivariable Cox analysis showed urinary diversion was not a risk factor of OS and CSS (HR 1.044, [95% CI 0.867-1.257] and 1.012 [0.748-1.368], respectively). Both OS and CSS were not significantly different, with median survival of ileal conduit and uretero-cutaneostomy were 19 [16-24] months and 19 [15-26] months respectively. Additionally, We found OS had the following risk factors: tumor stage (distant vs regional vs localized, 5.332 [3.610-7.875] vs 1.730 [1.375-2.176] vs 1), node density (>0.2 vs ≤0.2 vs none, 1.410 [1.047-1.898] vs 0.941 [0.658-1.344] vs 1) and age (1.067 [1.032-1.103] for each year). While CSS had the following risk factors: tumor stage (distant vs regional vs localized, 4.035 [2.046-7.959] vs 2.476 [1.651-3.713] vs 1), node density (>0.2 vs ≤0.2 vs none, 2.501 [1.645-3.804] vs 1.062 [0.590-1.914] vs 1) and tumor size (greater than 3 cm vs less than 3 cm, 1.596 [1.057-2.412] vs 1). Our analysis obtained 0.707 power for overall survival. CONCLUSION: Urinary diversion by uretero-cutaneostomy or by ileal conduit was not associated with overall and cancer-specific survival. It is reasonable to consider uretero-cutaneostomy as a regular procedure of urinary diversion in elderly bladder cancerpatients after radical cystectomy to avoid associate complications.
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: Jakko A Nieuwenhuijzen; Remco R de Vries; Alex Bex; Henk G van der Poel; Wim Meinhardt; Ninja Antonini; Simon Horenblas Journal: Eur Urol Date: 2007-09-18 Impact factor: 20.096
Authors: Jeffrey J Leow; Alexander P Cole; Thomas Seisen; Joaquim Bellmunt; Matthew Mossanen; Mani Menon; Mark A Preston; Toni K Choueiri; Adam S Kibel; Benjamin I Chung; Maxine Sun; Steven L Chang; Quoc-Dien Trinh Journal: Eur Urol Date: 2017-08-10 Impact factor: 20.096