1413 PREDICTING THE PROBABILITY OF 90-DAY SURVIVAL IN ELDERLY BLADDER CANCER PATIENTS TREATED WITH RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111413 PREDICTING THE PROBABILITY OF 90-DAY SURVIVAL IN ELDERLY BLADDER CANCER PATIENTS TREATED WITH RADICAL CYSTECTOMY Todd M. Morgan, Nedim Ruhotina, Kirk A. Keegan, Daniel A. Barocas, Sam S. Chang, David F. Penson, Peter E. Clark, Joseph A. Smith, and Michael S. Cookson Todd M. MorganTodd M. Morgan Nashville, TN More articles by this author , Nedim RuhotinaNedim Ruhotina Nashville, TN More articles by this author , Kirk A. KeeganKirk A. Keegan Nashville, TN More articles by this author , Daniel A. BarocasDaniel A. Barocas Nashville, TN More articles by this author , Sam S. ChangSam S. Chang Nashville, TN More articles by this author , David F. PensonDavid F. Penson Nashville, TN More articles by this author , Peter E. ClarkPeter E. Clark Nashville, TN More articles by this author , Joseph A. SmithJoseph A. Smith Nashville, TN More articles by this author , and Michael S. CooksonMichael S. Cookson Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1304AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the increased morbidity and mortality of radical cystectomy (RC) in elderly individuals with bladder cancer, numerous studies have demonstrated that surgery can provide a survival benefit. Given the inherent potential risks of RC in this population, however, we sought to better identify those patients at substantial risk of mortality following surgery. METHODS We evaluated 169 consecutive patients age 75 years and older treated with RC for bladder cancer at a single institution from 2000–2008 and in whom complete information was available. A Cox proportional hazards model was used to determine the value of pre-cystectomy clinical information (age, clinical stage [non-muscle invasive vs. muscle invasive], Charlson comorbidity index [CCI], and pre-operative albumin) in predicting 90-day survival post RC. These results were used to create a nomogram predicting the probability of 90-day survival post RC. The model was then subjected to 200 bootstrap resamples for internal validation. RESULTS The cohort had a mean age of 79.8 years (± 3.6 years), and there were a total of 18 deaths (11%) within 90 days post RC. In the Cox regression analysis, older age (HR 2.30, CI 1.22–4.32 for 75th vs. 25th percentile) and lower pre-operative albumin (HR 2.50, CI 1.40–4.45 for 25th vs. 75th percentile) were significant predictors of 90-day mortality. A nomogram based on age, clinical stage, CCI, and albumin predicting the likelihood of 90-day mortality with an accuracy of 75% was developed. Internal validation demonstrated a bootstrap-adjusted concordance index of 71%. CONCLUSIONS Balancing the risks and benefits of RC for elderly individuals with bladder cancer remains challenging. Given the relatively high 90-day mortality rate in these individuals, predictive tools are needed to help guide the management of these patients. This nomogram provides individualized risk estimations predicting the probability of 90-day mortality in patients 75 years and older post-RC, potentially informing pre-operative counseling and providing clinicians with an added tool to help individualize treatment decisions in this challenging patient population. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e566 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Todd M. Morgan Nashville, TN More articles by this author Nedim Ruhotina Nashville, TN More articles by this author Kirk A. Keegan Nashville, TN More articles by this author Daniel A. Barocas Nashville, TN More articles by this author Sam S. Chang Nashville, TN More articles by this author David F. Penson Nashville, TN More articles by this author Peter E. Clark Nashville, TN More articles by this author Joseph A. Smith Nashville, TN More articles by this author Michael S. Cookson Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...