SIU 2017: Risk Factors and an Attempt to Develop Pre-Operative Nomogram to Predict Perioperative Complications after Radial Cystectomy for Japanese People

Lisbon, Portugal ( Radical cystectomy (RC) is the gold standard for managing muscle-invasive and high-risk non-muscle-invasive bladder cancer, but is accompanied by significant operative risk. In this present study, the authors attempted to identify preoperative variables predicting perioperative complications after RC and develop a nomogram using a multi-institutional Japanese database.

This was a retrospective study reviewing 668 patients who underwent open RC with ileal conduit or neobladder at Hokkaido University hospital and 20 affiliated institutions between 1997 and 2010. Preoperative clinical and Comorbidity indices were collected. Complications occurring within 90-days of surgery were graded using the modified Clavien classification system. Univariate and multivariable logistic regression analyses were performed. Predictive accuracy of the nomogram was evaluated with the area under the receiver operating characteristics (ROC) curve.

The results demonstrated a total of 528 men and 140 Women (Ileal conduit: 493; Neobladder: 175) that were included in this study. There were a total of 160/668 patients (24.0%) with major complications within 90 days after RC. A multivariable model identified hospital volume (10 or more RCs per year) (odds ratio (OR): 0.57,95%CI 0.33-095, p=0.03), simultaneous nephroureterectomy (OR: 3.2, 95%CI 1.3-7.9, p=0.01), male gender (OR: 1.6, 95%CI 1.0- 2.6, p=0.049) and cardiovascular comorbidity (OR: 1.5, 95%CI 0.47-0.97, p=0.03) as independent predictors of 90-days major complications. Using stepwise selection, types of urinary diversion were added in the nomogram, resulting in a nomogram with an AUC of 0.62.

The authors concluded that annual cystectomy volume, simultaneous nephroureterectomy, male gender and cardiovascular comorbidity as independent predictors of major complications within 90-days of RC. The proposed nomogram demonstrated only a fair predictive performance. 

Presented by: Yamada S, Osawa T
Affiliation: Dept. of Urology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal