A population‐based competing‐risks analysis of the survival of patients treated with radical cystectomy for bladder cancer
Open Access
- 27 August 2010
- Vol. 117 (1), 103-109
- https://doi.org/10.1002/cncr.25345
Abstract
BACKGROUND. Patients treated with radical cystectomy represent a very heterogeneous group with respect to cancer‐specific and other‐cause mortality. Comorbidities and comorbidity‐associated events represent very important causes of mortality in those individuals. The authors examined the rates of cancer‐specific and other‐cause mortality in a population‐based radical cystectomy cohort. METHODS. The authors identified 11,260 patients treated with radical cystectomy for urothelial carcinoma of the urinary bladder between 1988 and 2006 within 17 Surveillance, Epidemiology, and End Results registries. Patients were stratified into 20 strata according to patient age and tumor stage at radical cystectomy. Smoothed Poisson regression models were fitted to obtain estimates of cancer‐specific and other‐cause mortality rates at specific time points after radical cystectomy. RESULTS. After stratification according to disease stage and patient age, cancer‐specific mortality emerged as the main cause of mortality in all patient strata. Nonetheless, at 5 years after radical cystectomy, between 8.5% and 27.1% of deaths were attributable to other‐cause mortality. The 3 most common causes of other‐cause mortality were other malignancies, heart disease, and chronic obstructive pulmonary disease. The most prominent effect on cancer‐specific mortality was exerted by locally advanced bladder cancer stages. Conversely, age was the main determinant of other‐cause mortality. Interestingly, even after adjusting for bladder cancer pathologic stage, cancer‐specific mortality was higher in older individuals than their younger counterparts. CONCLUSIONS. The current study provides a valuable graphical aid for prediction of cancer‐specific and other‐cause mortality according to disease stage and patient age. It can help clinicians to better stratify the risk‐benefit ratio of radical cystectomy. Hopefully, these findings will be considered in treatment decision making and during informed consent before radical cystectomy. Cancer 2011. © 2010 American Cancer Society.Keywords
This publication has 21 references indexed in Scilit:
- Mortality increases when radical cystectomy is delayed more than 12 weeksCancer, 2009
- Age‐adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancerCancer, 2008
- Five‐year survival after surgical treatment for kidney cancerCancer, 2007
- Outcomes of Radical Cystectomy for Transitional Cell Carcinoma of the Bladder: A Contemporary Series From the Bladder Cancer Research ConsortiumJournal of Urology, 2006
- Radical cystectomy in the elderlyCancer, 2005
- Factors Influencing Aggressive Therapy for Bladder Cancer: An Analysis of Data From the SEER ProgramJournal of Urology, 2003
- Neoadjuvant Chemotherapy plus Cystectomy Compared with Cystectomy Alone for Locally Advanced Bladder CancerNew England Journal of Medicine, 2003
- Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysisThe Lancet, 2003
- The Autopsy as a Measure of Accuracy of the Death CertificateNew England Journal of Medicine, 1985