Hong Kong Med J 2013;19:400–6 | Number 5, October 2013 | Epub 8 Aug 2013
Age, tumour stage, and preoperative serum albumin level are independent predictors of mortality after radical cystectomy for treatment of bladder cancer in Hong Kong Chinese
Eddie SY Chan, Sidney KH Yip, SM Hou, HY Cheung, WM Lee, CF Ng
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
OBJECTIVES. To evaluate the association between patient age, other clinical factors and mortality following radical cystectomy for treatment of bladder cancer.
DESIGN. Historical cohort study.
SETTING. A urology unit in Hong Kong.
PATIENTS. The outcomes of 117 patients who had radical cystectomies performed in one urological unit from 2003 to 2011 were reviewed. Demographic and perioperative data, including tumour stage, Charlson Comorbidity Index, and preoperative serum albumin levels were retrieved from computerised medical records. Risk factors for 30-day mortality, and cancer-specific, other-cause, and overall death rates at 5 years were calculated. The data were subsequently stratified and analysed according to age.
RESULTS. Of the 117 patients, 83 (71%) were aged 75 years or below. The mean follow-up duration was 31 (standard deviation, 29) months. Age, tumour stage, and preoperative serum albumin level, but not the Charlson Comorbidity Index, were found to be predictors of survival following radical cystectomy. The overall 30-day mortality rate was 3% in the full sample, 1% in patients aged 75 years or below, and 10% in patients aged over 75 years. There was no significant difference in 5-year cancer-caused mortalities between patients aged 75 years or below and those aged over 75 years (33% vs 33%, P=0.956). In patients older than 75 years, the 5-year other-cause and overall mortality rates were 47% and 80%, respectively; such rates were higher than those for younger patients (13% and 46%, respectively).
CONCLUSION. Age, tumour stage, and preoperative serum albumin level were predictors of survival after radical cystectomy. Non-cancer–related death played a crucial role in the overall mortality rate in elderly patients having radical cystectomy for bladder cancer.
Key words: Aged; Cystectomy; Mortality; Urinary bladder neoplasms
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