https://doi.org/10.4081/aiua.2021.1.15

Age above 70 years and Charlson Comorbidity Index higher than 3 are associated with reduced survival probabilities after radical cystectomy for bladder cancer. Data from a contemporary series of 334 consecutive patients

Vol. 93 No. 1 (2021)
Submitted: November 12, 2020
Accepted: December 7, 2020
Published: March 18, 2021
Radical cystectomy, Comorbidity, Age, Frail patient, Elderly
Abstract Views: 1198
PDF: 641
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Authors

Massimo Maffezzini
Department of Urology, Ospedale Nuovo Legnano, Ospedale Fornaroli Magenta, Milano, Italy.
Vincenzo Fontana
Clinical Epidemiology Unit, IRCCS Policlinico San Martino, University of Genova, Italy.
Andrea Pacchetti
Department of Urology, IRCCS Policlinico San Martino, University of Genova, Italy.
Federico Dotta
Department of Urology, IRCCS Policlinico San Martino, University of Genova, Italy.
Mattia Cerasuolo
Department of Urology, IRCCS Policlinico San Martino, University of Genova, Italy.
Davide Chiappori
Department of Urology, IRCCS Policlinico San Martino, University of Genova, Italy.
Giovanni Guano
Department of Urology, IRCCS Policlinico San Martino, University of Genova, Italy.
Guglielmo Mantica
guglielmo.mantica@gmail.com
Department of Urology, IRCCS Policlinico San Martino, University of Genova, Italy.
Carlo Terrone
Department of Urology, IRCCS Policlinico San Martino, University of Genova, Italy.

Objective: To assess the joint effect of age and comorbidities on clinical outcomes of radical cystectomy (RC).
Methods: 334 consecutive patients undergoing open RC for bladder cancer (BC) during the years 2005-2015 were analyzed. Pre-, peri- and post-operative parameters, including age at RC (ARC) and Charlson Comorbidity Index (CCI), were evaluated. Overall and cancer-specific survivals (OS, CSS) were assessed by univariate and multivariate modelling. Furthermore, a three-knot restricted cubic spline (RCS) was fitted to survival data to detect dependency between death-rate ratio (HR) and ARC.
Results: Median follow-up time was 3.8 years (IQR = 1.3-7.5) while median OS was 5.9 years (95%CL = 3.8-9.1). Globally, 180 patients died in our cohort (53.8%), 112 of which (62.2%) from BC and 68 patients (37.8%) for unrelated causes. After adjusting for preoperative, pathological and perioperative parameters, patients with CCI > 3 showed significantly higher death rates (HR = 1.61; p = 0.022). The highest death rate was recorded in ARC = 71-76 years (HR = 2.25; p = 0.034). After fitting an RCS to both OS and CSS rates, two overlapping nonlinear trends, with common highest risk values included in ARC = 70-75 years, were observed.
Conclusions: Age over 70 years and CCI > 3 were significant factors limiting the survival of RC and should both be considered when comparing current RC outcomes.

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How to Cite

Maffezzini, M., Fontana, V., Pacchetti, A., Dotta, F., Cerasuolo, M., Chiappori, D., Guano, G., Mantica, G., & Terrone, C. . (2021). Age above 70 years and Charlson Comorbidity Index higher than 3 are associated with reduced survival probabilities after radical cystectomy for bladder cancer. Data from a contemporary series of 334 consecutive patients. Archivio Italiano Di Urologia E Andrologia, 93(1), 15–20. https://doi.org/10.4081/aiua.2021.1.15

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