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- Dokumenttyp:
- Journal Article
- Autor(en):
- Maisch, Phillipp; Lunger, Lukas; Düwel, Charlotte; Schmid, Sebastian C; Horn, Thomas; Gschwend, Jürgen E; Sauter, Andreas; Heck, Matthias M
- Titel:
- Outcomes of palliative cystectomy in patients with locally advanced pT4 bladder cancer.
- Abstract:
- BACKGROUND: Radical cystectomy (Cx) is the standard of care for muscle-invasive bladder cancer (BCa). In locally advanced pT4 BCa the oncologic outcome is inexplicit but Cx may be necessary for palliation. OBJECTIVES: The aim of this retrospective study was to evaluate the outcomes of Cx performed in patients with locally advanced pT4 BCa and to identify patient subgroups with improved outcome. METHODS: Between 2008 and 2017, we identified 76 of 905 patients who underwent Cx for pT4 BCa at a single tertiary referral center. The physical patients' status was estimated according to the American Society of Anesthesiologists (ASA) classification. For the classification of postoperative complication rates, the Clavien-Dindo grading was used. Time-to-event variables with log-rank statistics were calculated with the use of the Kaplan-Meier method. RESULTS: Median age was 74 years (range 42-90). Preoperatively, the physical status was estimated poor in 40 (52%) patients (ASA-score of ≥3). Overall, 19 (25%) patients had pT4b BCa, 41 (54%) patients were lymph node positive (c/pN+) and 14 (18%) patients had distant metastases (c/pM+). Within 30 and 90 days after surgery, 21% and 30% of the patients, respectively, developed severe complications (Clavien-Dindo grade ≥3). Overall, 30- and 90-day mortality rates were 9% and 11%, respectively. Moreover, 86% and 75% of patients who died within 30 and 90 days after surgery, respectively, had an ASA-score ≥3. At a median postoperative follow-up of 8 months (range 0-85), 53 (70%) patients have died. During the follow-up period, 46% of the patients died due to progressive disease, 16% died of a noncancer-specific cause, and for 8% of the patients, the reason remains unknown. Median overall survival (OS) and cancer-specific survival were 13.0 and 16.0 months, respectively. In subgroup analyses ASA-score ≥3 and hemoglobin <11.7 g/dl was significantly associated with poor OS. No statistically significant differences were detected between subgroups. CONCLUSION: Cx performed in patients with locally advanced pT4 BCa is associated with an increased mortality rate within 90 days postoperatively. Our study revealed that the ASA-score is a relevant and easily available tool to rate the patient´s condition and estimate postoperative outcome.
- Zeitschriftentitel:
- Urol Oncol
- Jahr:
- 2021
- Band / Volume:
- 39
- Heft / Issue:
- 6
- Seitenangaben Beitrag:
- 368.e11-368.e17
- Volltext / DOI:
- doi:10.1016/j.urolonc.2020.11.042
- PubMed:
- http://view.ncbi.nlm.nih.gov/pubmed/33431328
- Print-ISSN:
- 1078-1439
- TUM Einrichtung:
- Institut für Diagnostische und Interventionelle Radiologie; Urologische Klinik und Poliklinik
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