Predictive value of different parameters for estimating the first 90-days and long-term survival following radical cystectomy
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Tarih
2020
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info:eu-repo/semantics/openAccess
Özet
Objective: We aimed to define the prognostic risk factors which may have an impact on the survival by assessing the effects of the different clinicalparameters and several comorbidity classifications on the oncologic outcomes within the first 90 days and long-term follow-up after radical cystectomy.Materials and Methods: Fifty-two patients who underwent radical cystectomy between June 2013-and June 2017 due to bladder tumors and whosedata were fully accessible, have been assessed retrospectively. The demographical, clinical and pathologic data of the patients were recorded alongwith the progression and mortality rates within the first 90 days follow up period and the subsequent long-term follow-up. Age-adjusted CharlsonComorbidity index (ACCI), Eastern Cooperative Oncology Group (ECOG) score, American Society of Anesthesiologists (ASA) score, Framinghamrisk score, Preoperative Score to Predict Postoperative Mortality, Rockwood frailty index, preoperative serum hemogram parameters and estimatedglomerular filtration rate (eGFR) were all calculated and recorded.Results: Out of the 52 patients the average age was 68.21±6.47, distant metastasis was observed in 17 (32.7%) patients during monthly follow upsat an average of 37.52±26.15 [minimum (min)=1, maximum (max)= 96], while morbidity was observed in 23 patients (44.2%). According to receiveroperativing characteristic analysis, the two parameters as the most reliable tool in the prediction of the mortality during long term follow up were eGFR[area under the curve (AUC)=0.754, p<0.001] and Framingham score (AUC=0.782, p=0.001). It has also been observed in multivariate analysis thatFramingham score and Clavien-Dindo classification was the most meaningful predictive factor in the estimation of the mortality in the first 90 daysperiod, progression free survival (PFS) and overall survival (OS); eGFR for PFS and OS; ECOG score for PFS; ASA score for OS; monazite/lymphocyterate for the estimation of the mortality in the first 90 days period. In addition, pT3-4 stage has been observed to be much more meaningful in theprediction of PFS, non-transitional cell carcinoma pathology for PFS and OS, and, lymph node positivity for OS.Conclusion: Radical cystectomy is a surgical procedure with high morbidity and mortality due to perioperative complications both in the first 90-daysof the postoperative period and long-term follow-up.We found that Framingham score and eGFR were superior and easily applicable parameters inprediction of PFS and OS, whereas Framingham score and MLR were better in prediction of the first 90-days mortality. In this way, we think that wecan identify patients who are more suitable for cystectomy, so we can provide more successful postoperative follow-up and treatment management.
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Üroonkoloji Bülteni
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Cilt
19
Sayı
1
