Preoperative comorbidity indices predictive in bladder cancer

For patients with urothelial carcinoma of the bladder (UCB) who are undergoing radical cystectomy (RC), the measurement of preoperative comorbidity indices can improve prognostication in terms of cancer-independent mortality (CIM), study results show.

The Adult Comorbidity Evaluation-27 (ACE27) and American Society of Anesthesiologists (ASA) score together with dichotomized age emerged as the best prognostic model and according to the researchers "must be integrated in the preoperative setting for patients undergoing RC."

"Comorbidity offers a way to stratify UCB patients beyond known risk factors, such as age and tumor-associated characteristics," Hans-Martin Fritsche (University of Regensburg, Germany) and colleagues comment in European Urology.

In the current study, they assessed which of the well-established and evaluated comorbidity and performance status indices best predicts the survival outcome of patients undergoing RC for UCB - namely, ASA score; ACE27; Eastern Cooperative Oncology Group (ECOG) performance status; Charlson Comorbidity Index (CCI); and Age-Adjusted Charlson Comorbidity Index (ACCI).

For this they performed a retrospective multicenter study among 555 unselected consecutive patients who underwent RC for UCB from 2000 to 2010.

Fritsche and colleagues report that in multivariable Cox regression analyses none of the comorbidity indices examined were significant predictors for cancer-specific mortality (CSM). By contrast, each of the assessed comorbidity indices was a significant predictor for CIM.

To create a clinically valuable tool, they devised a weighted prognostic model containing the clinical variables of age (dichotomized at 75 years), gender, clinical tumor stage, and body mass index (BMI).

When adding the new variable, ASA/ACE27, to the basic model the predictive accuracy was increased by 3.2%.

Three risk groups were stratified based on the two weighted variables of age (cutoff 75 years), and ASA (1-2 vs 3-4) plus ACE27 (0-1 vs 2).

The low-risk group (n=275) was defined as those aged 75 years or younger with neither ASA 3-4 nor ACE27 2-3 and served as the reference. The intermediate-risk group (n=210) were either older than 75 years or had an ASA score of 3-4 and ACE27 2-3, and were more than threefold more likely to die than the reference group.

The high-risk group (n=70) were older than 75 years and had an ASA score of 3-4 and ACE27 2-3. Patients in this group exhibited a CIM risk almost seven times greater than patients in the low-risk group.

"Future investigations and studies are required to determine the optimal therapeutic options for patients with higher comorbidity and/or decreased physical status," the researchers conclude.

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