To investigate the impact of socioeconomic status-related parameters on competing (non-bladder cancer) mortality after radical cystectomy.
A total of 1,268 consecutive patients who underwent radical cystectomy for urothelial or undifferentiated bladder cancer at our institution between 1993 and 2016 with a mean age of 69 years (median 70 years) were studied. The mean -follow-up of the censored patients was 7.2 years (median 5.7 years). Proportional hazard models for competing risk were used to identify predictors of non-bladder cancer (competing) mortality. The following parameters were included into multivariate analyses: age, American Society of Anesthesiologists physical status classification, Charlson score, gender, level of education, smoking status, marital status, local tumour stage, lymph node status, adjuvant and neoadjuvant chemotherapy.
Besides age and both comorbidity classifications, the socioeconomic status-related parameters gender (female versus male, hazard ratio [HR] 0.58, 95% CI 0.40-0.84, p = 0.0042), level of education (university degree or master craftsman versus others, HR 0.76, 95% CI 0.56-0.1.03, p = 0.0801), smoking status (current smoking versus others, HR 1.47, 95% CI 1.10-1.96, p = 0.0085) and marital status (married versus others, HR 0.68, 95% CI 0.50-0.92, p = 0.0133) were independent predictors of competing mortality after radical cystectomy. If considered in combination (multiplication of HRs), the prognostic impact of socioeconomic parameters superseded that of the investigated comorbidity classifications.
Socioeconomic status-related parameters may provide important information on the long-term competing mortality risk after radical cystectomy supplementary to chronological age and comorbidity.
Urologia internationalis. 2019 Oct 22 [Epub ahead of print]
Michael Froehner, David Muallah, Rainer Koch, Matthias Hübler, Angelika Borkowetz, Ulrike Heberling, Johannes Huber, Manfred P Wirth, Christian Thomas
Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany, ., Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany., Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany., Department of Anesthesiology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany.