Peri-operative mortality and long-term survival after partial versus radical cystectomy for muscle invasive bladder cancer
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Keywords
bladder cancer, radical cystectomy, partial cystectomy, perioperative mortality, long-term outcomes
Abstract
Objective: The aim of the study was to compare partial cystectomy (PC) and radical cystectomy (RC) with respect to 90-day mortality as well as long-term, all cause (ACM) and cancer specific mortality (CSM).
Methods: Using the SEER-Medicare database 3913 patients with T2-T3 urothelial carcinoma of the urinary bladder (UCUB) who underwent either RC (n = 3419) or PC (n = 494) were identified. After propensity score matching to reduce potential treatment selection bias, 90-day mortality, ACM-free and CSM-free rates between patients treated with PC and RC were estimated. Multivariable regression models (MVA) addressed 90-day mortality as well as 5-years ACM and CSM.
Results: After matching, 33% (n = 494) and 67% (n = 988) patients treated respectively with PC or RC remained. Median follow-up was 26 months. The 90-day mortality rate was 3.2% (n = 16) after PC and 8.1% (n = 80) after RC (P = 0.001). In MVA, PC vs. RC was associated with a lower 90-day mortality (P < 0.001). At 5 years the ACM-free survival rate was 38% after PC and 40% after RC (P = 0.3) and failed to differ in MVA (P = 0.9). At 5 years the CSM-free survival rate was 59% after PC and 62% after RC (P = 0.2) and also failed to differ in MVA (P = 0.57). The same results were observed after restriction to patients with pT2N0 UCUB.
Conclusions: Relative to RC, PC is associated with lower short-term mortality and the same long-term ACM and CSM rates. These observations should encourage greater consideration to PC in those selected cases when this type of surgery may be applied.
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References
2. Gakis G, Efstathiou J, Lerner SP, Cookson MS, Keegan KA, et al. (2013) ICUD-EAU International Consultation on Bladder Cancer 2012: Radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. European urology 63: 45-57.
3. Capitanio U, Isbarn H, Shariat SF, Jeldres C, Zini L, et al. (2009) Partial cystectomy does not undermine cancer control in appropriately selected patients with urothelial carcinoma of the bladder: a population-based matched analysist. Urology 74: 858-864.
4. Kassouf W, Swanson D, Kamat AM, Leibovici D, Siefker-Radtke A, et al. (2006) Partial cystectomy for muscle invasive urothelial carcinoma of the bladder: a contemporary review of the M. D. Anderson Cancer Center experience. The Journal of urology 175: 2058-2062.
5. Smaldone MC, Jacobs BL, Smaldone AM, Hrebinko RL, Jr. (2008) Long-term results of selective partial cystectomy for invasive urothelial bladder carcinoma. Urology 72: 613-616.
6. Knoedler JJ, Boorjian SA, Kim SP, Weight CJ, Thapa P, et al. (2012) Does partial cystectomy compromise oncologic outcomes for patients with bladder cancer compared to radical cystectomy? A matched case-control analysis. The Journal of urology 188: 1115-1119.
7. Garg T, Chen LY, Kim PH, Zhao PT, Herr HW, et al. (2013) Preoperative Serum Albumin Is Associated With Mortality and Complications After Radical Cystectomy. BJU international.
8. Aziz A, May M, Burger M, Palisaar RJ, Trinh QD, et al. (2013) Prediction of 90-day Mortality After Radical Cystectomy for Bladder Cancer in a Prospective European Multicenter Cohort. European urology.
9. Porter MP, Gore JL, Wright JL (2011) Hospital volume and 90-day mortality risk after radical cystectomy: a population-based cohort study. World journal of urology 29: 73-77.
10. Konety BR, Allareddy V, Herr H (2006) Complications after radical cystectomy: analysis of population-based data. Urology 68: 58-64.
11. Roghmann F, Sukumar S, Ravi P, Trinh VQ, Meskawi M, et al. (2014) Radical cystectomy in the elderly: national trends and disparities in perioperative outcomes and quality of care. Urologia internationalis 92: 27-34.
12. Kates M, Gorin MA, Deibert CM, Pierorazio PM, Schoenberg MP, et al. (2014) In-hospital death and hospital-acquired complications among patients undergoing partial cystectomy for bladder cancer in the United States. Urologic oncology 32: 53 e59-14.
13. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF (2002) Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40: IV-3-18.
14. Klabunde CN, Potosky AL, Legler JM, Warren JL (2000) Development of a comorbidity index using physician claims data. J Clin Epidemiol 53: 1258-1267.
15. Sun M, Abdollah F, Liberman D, Abdo A, Thuret R, et al. (2011) Racial disparities and socioeconomic status in men diagnosed with testicular germ cell tumors: a survival analysis. Cancer 117: 4277-4285.
16. D'Agostino RB, Jr. (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Statistics in medicine 17: 2265-2281.
17. Ho DE, Imai, K., King, G., Stuart, E. (2003) MatchIt: Nonparametric preprocessing for parametric causal inference. J Stat Softw: 42.
18. Lawrentschuk N, Colombo R, Hakenberg OW, Lerner SP, Mansson W, et al. (2010) Prevention and management of complications following radical cystectomy for bladder cancer. European urology 57: 983-1001.
19. Kaufman DS, Winter KA, Shipley WU, Heney NM, Wallace HJ, 3rd, et al. (2009) Phase I-II RTOG study (99-06) of patients with muscle-invasive bladder cancer undergoing transurethral surgery, paclitaxel, cisplatin, and twice-daily radiotherapy followed by selective bladder preservation or radical cystectomy and adjuvant chemotherapy. Urology 73: 833-837.
20. Efstathiou JA, Spiegel DY, Shipley WU, Heney NM, Kaufman DS, et al. (2012) Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience. European urology 61: 705-711.
21. Vickers AJ, Bennette C, Kibel AS, Black A, Izmirlian G, et al. (2013) Who should be included in a clinical trial of screening for bladder cancer?: a decision analysis of data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Cancer 119: 143-149.
22. Lughezzani G, Sun M, Shariat SF, Budaus L, Thuret R, et al. (2011) A population-based competing-risks analysis of the survival of patients treated with radical cystectomy for bladder cancer. Cancer 117: 103-109.
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Alessandro Larcher, URI, Urological Research Institute, Division Of Oncology, Vita-Salute San Raffaele University, Milan, Italy
Alessandro Larcher, M.D.Dept. of Urology
IRCCS H. San Raffaele
Vita-Salute University
Via Olgettina 60
20132 Milan, Italy
Ph. +39 02 2643 7453
Fax +39 02 2643 5608
