Prognostic indicators of mortality and morbidity following radical cystectomy for carcinoma of bladder: 12-year experience from a tertiary centre in Hong Kong

Abstract

Objectives: the aim of this study was to determine factors that predict mortality and complications after radical cystectomy. Methods: Patients with carcinoma of bladder and radical cystectomy performed between 1st March 2003 to 31st December 2015 were identified. Demographics, comorbidities, pre-operative investigations and tumour staging were retrieved for analysis. Results: Ninety-two patients with median age of 67.0 and mean follow-up duration of 54.9 months were included. The 5-year cancer-specific and overall survival rate were 72.8% and 62.0% respectively. The 30-day mortality rate was 1.1% and overall complication rate was 28.3%. On univariate analysis, patients with pre-operative albumin <40g/L, age-adjusted Charlson Comorbidity Index >4 and Neutrophil-to-Lymphocyte ratio >3.0 were associated with higher all-cause mortality rate (57.9%, p=0.015; 65.6%, p=0.003 and 54.8%, p=0.036 respectively) and lower 5-year overall survival rate (44.7%, p=0.001; 46.9%, p=0.030 and 50.0%, p=0.011 respectively). On multivariate analysis, only albumin <40g/L and age adjusted CCI were statistically significant (OR 2.161, p=0.030 and OR 2.289, p=0.013 respectively). There was no significant impact on complication rate. Age, body weight and perioperative transfusion were not associated with increased mortality or morbidity. Conclusion: Age adjusted CCI >4 and pre-operative albumin <40g/L were useful indicators for post radical cystectomy overall mortality and long term survival. Evaluation of patient’s comorbidities was more important than chronological age in patients with carcinoma of bladder.