AUA 2013 - Session Highlights: Comparative performance of comorbidity indices for estimating perioperative and 5-year all-cause mortality following radical cystectomy

SAN DIEGO, CA USA ( - Dr. Stephen Boorjian and colleagues from Mayo Clinic investigated the comparative ability of various comorbidity indices to predict perioperative and 5-year all-cause mortality (ACM) following radical cystectomy.

They evaluated 891 patients who underwent RC at Mayo Clinic between 1994-2005. The associations of American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI), Elixhauser index (EI), and Eastern Cooperative Oncology Group (ECOG) performance status, with outcome, were assessed using Cox regression models. Model performance was compared with area under receiver operating curves (AUC).

On multivariate analysis, locally-advanced (pT3/4) pathologic tumor stage (HR 5.54;p=0.0004), as well as the comorbidity indices EI (HR 1.50;p=0.001), ASA (HR 3.10;p=0.0008), and ECOG (HR 2.53;p < 0.0001) were significantly associated with 90-day mortality, while higher body mass index (HR 1.06;p=0.05) trended to predict death within 90 days of RC. Overall postoperative 5-year survival was 53%. Older patient age (HR 1.04;p < 0.0001), muscle-invasive (HR 1.93;p=0.001) or extravesical (HR 5.75;p < 0.0001) tumor stage, positive lymph nodes (HR 2.06;p=0.0009), as well as CCI (HR 1.23;p < 0.0001), EI (HR 1.28;p < 0.0001), ASA (HR1.44;p=0.007), and ECOG (HR 1.97;p < 0.0001) were independent predictors of 5-year ACM. Notably, of the comorbidity indices, only CCI (HR 1.21;p < 0.0001) was significantly associated with the 5-year risk of cancer-specific mortality after RC. Median follow-up after RC was 10.1 years, during which time 576 patients died, including 340 who died of bladder cancer.

They concluded that patient comorbidity status is associated with the risks of perioperative death and 5-year ACM following RC, and, in fact, the incorporation of CCI, EI, or ECOG significantly improves prediction of 5-year ACM. Further studies are warranted to validate the relative prognostic value of various comorbidity indices.

Presented by Stephen Boorjian, Simon Kim, Matthew Tollefson, Alonso Carrasco, John Cheville, R. Houston Thompson, Prabin Thapa, and Igor Frank at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA

Reported for by Reza Mehrazin, MD


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