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AUA 2017

AUA 2017: The prognostic value of postoperative clinical and laboratory parameters regarding the oncological outcome of patients undergoing radical cystectomy for urothelial cell carcinoma of the bladder

Boston, MA (UroToday.com) In this study, the authors evaluated the influence of immediate postoperative clinical parameters on overall prognosis. From 2004-2016, 883 radical cystectomy were performed at a single institution. To avoid ambiguity, patients who underwent neoadjuvant and adjuvant systemic chemotherapy were excluded. Of all patients, median age was 70, and 76% of the patients were male. The investigators found postoperative day 1 Cr above 1.2 mg/dL predicted worse overall survival. In addition, incremental increase in CRP also resulted in a statistically significant decrease in survival. On the other hand, wound healing disorders postoperatively was identified as a clinical predictor for worse survival, with an OR of 1.51. These differences were confirmed on comparison of OS by the log rank test.

While preoperative predictors have been extensively studied, the prognostic impact of postoperative clinical and laboratory factors on overall survival in patients following radical cystectomy remains relatively unknown. While this study attempts to answer this important question, the length of followup and the short term nature of the results call the conclusion into question. Immediate postoperative fluctuation in laboratory values can be due to a host of different reasons: patients’ comorbidities, inflammation arising from surgery, or the biology of the patients’ disease. Although intriguing, the link between inferior postoperative renal function and inflammation with poor survival need to be further explored. Rather than using the two laboratory values as a one-size-fits-all postoperative predictor, the different processes associated with abnormal lab values need to be elucidated. Postoperative complications may also be a surrogate for frailty, immunodeficiency, or other factors known to adversely affect outcome. Furthermore, the study may be strengthened by using the changes in the laboratory values rather than the absolute postoperative value as the predictor.

Presenter: Jan-Friedrich Jokisch, MD

Written By: Roger Li MD Urologic Oncology Fellow, UT MD Anderson Cancer Center
Ashish M. Kamat MD Wayne B. Duddlesten Professor, UT MD Anderson Cancer Center

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA