Independent Risk Factor For Overall Mortality Research Articles

MP41-06 THE ROLE OF MALNUTRITION UNIVERSAL SCREENING TOOL IN PREDICTING OUTCOMES AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive II (MP41)1 Sep 2021MP41-06 THE ROLE OF MALNUTRITION UNIVERSAL SCREENING TOOL IN PREDICTING OUTCOMES AFTER RADICAL CYSTECTOMY Ziv Savin, Aviv Kupershmidt, Snir Dekalo, Dorel Poulin, Ofer Yossepowitch, Alon Lazarovich, Barak Rosenzwieg, Reut Shashar, Azik Hoffman, Jonathan Gal, Miki Haifler, and Roy Mano Ziv SavinZiv Savin More articles by this author , Aviv KupershmidtAviv Kupershmidt More articles by this author , Snir DekaloSnir Dekalo More articles by this author , Dorel PoulinDorel Poulin More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , Alon LazarovichAlon Lazarovich More articles by this author , Barak RosenzwiegBarak Rosenzwieg More articles by this author , Reut ShasharReut Shashar More articles by this author , Azik HoffmanAzik Hoffman More articles by this author , Jonathan GalJonathan Gal More articles by this author , Miki HaiflerMiki Haifler More articles by this author , and Roy ManoRoy Mano More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002062.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Malnutrition Universal Screening Tool (MUST) integrates body mass index and unplanned weight loss to assess the nutritional status of patients, and was previously associated with adverse outcomes after gastrointestinal operations. The predictive role of MUST among patients undergoing radical cystectomy is unknown. METHODS: We conducted a multi-center retrospective analysis of 227 patients who underwent radical cystectomy for bladder cancer in 4 medical centers between 2015-2019. Patients were stratified according to the MUST score [MUST=0 (n=188) vs. MUST ≥1 (n=39)]. Baseline clinical, pathological and functional characteristics were compared between groups. Endpoints were 30-day postoperative morbidity, cancer-specific-survival (CSS) and overall survival (OS). Kaplan-Meier curves and cox regression analyses were used to evaluate survival and identify predictors of outcome. RESULTS: Median age of the study cohort was 69 years (IQR 63-74). Median duration of follow up was 23 months (IQR 14-35). Thirty-day major postoperative complication rate (Clavien-Dindo grade 3-5) was 17%. Estimated 2-year OS and CSS rates were 73% and 75%, respectively. Baseline characteristics were not different between the MUST groups. OS and CSS were significantly lower (p <0.001) in the malnourished group (MUST ≥1) with medians of 32 months (95%CI 20-44) and 33 months (95%CI 27-46), respectively, compared to the MUST=0 group (medians were not reached, Figure 1). There was no difference in post-operative complication rates between the groups. On multivariable analysis, MUST ≥1 was found to be an independent risk factor for overall-mortality (HR=2.4, 95%CI 1.4-4.2) and cancer-specific-death (HR=2.5, 95% CI 1.4-4.4). CONCLUSIONS: High MUST scores are associated with decreased survival in patients after radical cystectomy. Therefore, the MUST score may assist in perioperative evaluation and patient selection. Future studies should focus on whether improving the nutritional status of malnourished patients will result in improved ontological outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e762-e762 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziv Savin More articles by this author Aviv Kupershmidt More articles by this author Snir Dekalo More articles by this author Dorel Poulin More articles by this author Ofer Yossepowitch More articles by this author Alon Lazarovich More articles by this author Barak Rosenzwieg More articles by this author Reut Shashar More articles by this author Azik Hoffman More articles by this author Jonathan Gal More articles by this author Miki Haifler More articles by this author Roy Mano More articles by this author Expand All Advertisement Loading ...

Prognostic significance of bladder neck involvement in non-muscle-invasive bladder cancer: A SEER database analysis with 19,919 patients.

PurposeTo study prognostic values of bladder neck involvement (BNI) and survival outcomes in non‐muscle‐invasive bladder cancer (NMIBC).Method and materialsThe national Surveillance, Epidemiology, and End Results database (2004–2015) was applied to gain further insight into the prognostic values of BNI and 19,919 patients diagnosed with NMIBC were included in our study. We used the Kaplan–Meier method with the log‐rank test and subgroup analyses to evaluate cancer‐specific survival (CSS) and overall survival (OS). In addition, the multivariable Cox proportional hazard model and propensity score matching (PSM) were utilized.ResultsIn all, 3446 patients with BNI and 16,473 patients with sites except for bladder neck were enrolled in our study. Compared with other sites, a tendency toward a higher proportion of higher grade (p < 0.001), bigger tumor size (p < 0.001), and more patients with T1 and Tis stage (p < 0.001) was seen in BNI group. After 1:1 PSM, 3425 matched pairs were selected. Under the survival analyses, the BNI group had a lower survival probability in both OS (p = 0.0056) and CSS analyses (p < 0.0001) in NMIBC patients. However, in the subgroup analysis, only observed in the Ta and T1 stage in terms of CSS (all p < 0.05), and patients with Tis stage failed to show statistical survival differences (p > 0.05). In addition, subgroups stratified by tumor size and grade all revealed poor prognosis of BNI in NMIBC patients. Moreover, better survival outcomes of OS were observed in BNI patients who received radical cystectomy (p = 0.02) or chemotherapy (p < 0.001) multivariable Cox regression after PSM revealed that the BNI group had a higher risk of overall mortality (OM) (BNI vs. other sites hazards ratios [HR]: 1.127, 95% CI: 1.154–1.437, p < 0.001) and cancer‐specific mortality (CSM) (BNI vs. other sites HR: 1.127, 95% CI: 1.039–1.223, p < 0.001), while before PSM, similar situations were only existed in CSM (BNI vs. other sites HR: 1.288, 95% CI: 1.154–1.437, p < 0.001).ConclusionsThe prognosis of BNI was poorer than that of the other sites. BNI was an independent risk factor for OM and CSM in patients with NMIBC, especially for those with Ta or T1 stage.

Re-Operative Aortic Arch Surgery in a Contemporary Series

Re-operative aortic arch operations (REDO) following previous cardiac surgery are challenging procedures associated with significant morbidity and mortality. We investigated post-operative outcomes for patients undergoing REDO and identified risk-factors for mortality in a contemporary series. From 1/2005-6/2018, 365 consecutive patients at an academic center underwent REDO: 257 HEMIARCH and 108 COMPLETE arch (45 stage I elephant trunk, 63 total arch) replacements. Outcomes included mortality and major adverse events. Long-term survival was determined with Kaplan-Meier analysis, and risk-factors for mortality were assessed with Cox proportional hazards regression. Operative mortality for the entire cohort was 6.8%, and rates of stroke, cardiac arrest, and renal failure were 6.0%, 7.4%, and 10.4%. Compared to HEMIARCH, COMPLETE patients had an increased incidence of renal failure requiring dialysis (15.7% vs 8.2%, p = 0.031) and re-exploration for bleeding or delayed chest closure (19.4% vs. 11.7%, p = 0.051). Although operative mortality was similar in both cohorts, long-term follow-up mortality (38.0% vs 26.8%, p = 0.047) was higher among COMPLETE vs. HEMIARCH. Predictors ofoverall mortalityamong all-comers undergoing REDO included older age, low body surface area, endocarditis, ejection fraction <30%, emergent status of operation, extended cardiopulmonary bypass duration, intra-aortic balloon pump use, and a more extensive arch operation. Previous aortic surgery was not a risk-factor for mortality. Among all-comers undergoing REDO, survival was 81.4% at 1 year, 66.7% at 5 years, and 56.4% at 10 years of follow-up. While early postoperative outcomes are similar among HEMIARCH and COMPLETE, a more extensive arch-replacement is an independent risk-factor for overall mortality in REDO. Using appropriate clinical indications in the current era, REDO remains a viable option for selected patients.

Racial Disparities with Esophageal Cancer Mortality at a High-Volume University Affiliated Center: An All ACCESS Invitation

BackgroundEsophageal cancer (EC) has a dismal prognosis with 5-year survival < 19%. Black patients with EC have higher mortality than white patients, but the cause of this disparity is unclear. We sought to investigate the impact of race upon overall mortality (OM) among EC patients at our institution. MethodsWe performed a single-center retrospective review of all patients diagnosed with EC between January 2010 through December 2016 with follow-up through October 2017. We compared the difference among categorical variables and mortality using Fisher's exact test. Odds ratios (OR) and hazard regression (HR) were constructed to analyze treatment options by race. The Kaplan-Meier method was used to plot OM curves by race. We also used a logistic regression analysis to construct a predictive model for mortality based on histology and race. ResultsWe identified 77 patients (62% male) diagnosed with EC. There was no difference in treatments offered based on race. After adjusting for age, histology and stage, we found mortality was significantly higher in blacks when compared to whites (HR 14.07, 95% CI [2.33–129.70] p < 0.008). Our predictive model revealed that blacks had a higher probability of mortality at all stages of EC. ConclusionsWe found race to be an independent risk factor for OM in EC patients. This likely reflects differences in healthcare utilization or access, as evidenced by higher prevalence of Stage IV EC in black patients. Continued investigation is needed to address this disparity locally and nationally.