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Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States

BACKGROUND: Although radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer (MIBC), for many patients the risks versus benefits of RC may favor other approaches. We sought to define the landscape of early postcystectomy mortality in the United States and identify patients...

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Autores principales: Marqueen, Kathryn E, Waingankar, Nikhil, Sfakianos, John P, Mehrazin, Reza, Niglio, Scot A, Audenet, François, Jia, Rachel, Mazumdar, Madhu, Ferket, Bart S, Galsky, Matthew D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349610/
https://www.ncbi.nlm.nih.gov/pubmed/30734024
http://dx.doi.org/10.1093/jncics/pky075
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author Marqueen, Kathryn E
Waingankar, Nikhil
Sfakianos, John P
Mehrazin, Reza
Niglio, Scot A
Audenet, François
Jia, Rachel
Mazumdar, Madhu
Ferket, Bart S
Galsky, Matthew D
author_facet Marqueen, Kathryn E
Waingankar, Nikhil
Sfakianos, John P
Mehrazin, Reza
Niglio, Scot A
Audenet, François
Jia, Rachel
Mazumdar, Madhu
Ferket, Bart S
Galsky, Matthew D
author_sort Marqueen, Kathryn E
collection PubMed
description BACKGROUND: Although radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer (MIBC), for many patients the risks versus benefits of RC may favor other approaches. We sought to define the landscape of early postcystectomy mortality in the United States and identify patients at high risk using pretreatment variables. METHODS: We identified patients with MIBC (cT2-T4aN0M0) who underwent RC without perioperative chemotherapy within the National Cancer Database (2003–2012). Using multistate multivariable modeling, we calculated time spent in three health states: hospitalized, discharged, and death more than 90 days postcystectomy. Cross-validation was performed by geographic region. Time spent in each state was weighted by utility to determine 90-day quality-adjusted life days (QALDs). RESULTS: Among 7922 patients, 90-day mortality was 7.6% (8.0% for lower and 6.7% for higher volume hospitals). Increasing age, clinical T stage, Charlson Comorbidity Index, and lower volume were associated with higher 90-day mortality and were included in the model. Cross-validation revealed appropriate performance (C-statistics of 0.53–0.74; calibration slopes of 0.50–1.67). The model predicted 25% of patients had a 90-day mortality risk higher than 10%, and observed 90-day mortality in this group was 14.0% (95% CI = 12.5% to 15.6%). Mean quality-adjusted life days (QALDs) was 63 (range = 44–68). CONCLUSIONS: RC is associated with relatively high early mortality risk. Pretreatment variables may identify patients at particularly high risk, which may inform clinical trial design, facilitate shared decision making, and enhance quality improvement initiatives.
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spelling pubmed-63496102019-02-05 Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States Marqueen, Kathryn E Waingankar, Nikhil Sfakianos, John P Mehrazin, Reza Niglio, Scot A Audenet, François Jia, Rachel Mazumdar, Madhu Ferket, Bart S Galsky, Matthew D JNCI Cancer Spectr Article BACKGROUND: Although radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer (MIBC), for many patients the risks versus benefits of RC may favor other approaches. We sought to define the landscape of early postcystectomy mortality in the United States and identify patients at high risk using pretreatment variables. METHODS: We identified patients with MIBC (cT2-T4aN0M0) who underwent RC without perioperative chemotherapy within the National Cancer Database (2003–2012). Using multistate multivariable modeling, we calculated time spent in three health states: hospitalized, discharged, and death more than 90 days postcystectomy. Cross-validation was performed by geographic region. Time spent in each state was weighted by utility to determine 90-day quality-adjusted life days (QALDs). RESULTS: Among 7922 patients, 90-day mortality was 7.6% (8.0% for lower and 6.7% for higher volume hospitals). Increasing age, clinical T stage, Charlson Comorbidity Index, and lower volume were associated with higher 90-day mortality and were included in the model. Cross-validation revealed appropriate performance (C-statistics of 0.53–0.74; calibration slopes of 0.50–1.67). The model predicted 25% of patients had a 90-day mortality risk higher than 10%, and observed 90-day mortality in this group was 14.0% (95% CI = 12.5% to 15.6%). Mean quality-adjusted life days (QALDs) was 63 (range = 44–68). CONCLUSIONS: RC is associated with relatively high early mortality risk. Pretreatment variables may identify patients at particularly high risk, which may inform clinical trial design, facilitate shared decision making, and enhance quality improvement initiatives. Oxford University Press 2019-01-28 /pmc/articles/PMC6349610/ /pubmed/30734024 http://dx.doi.org/10.1093/jncics/pky075 Text en © The Author(s) 2019. Published by Oxford University Press. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Article
Marqueen, Kathryn E
Waingankar, Nikhil
Sfakianos, John P
Mehrazin, Reza
Niglio, Scot A
Audenet, François
Jia, Rachel
Mazumdar, Madhu
Ferket, Bart S
Galsky, Matthew D
Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States
title Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States
title_full Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States
title_fullStr Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States
title_full_unstemmed Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States
title_short Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States
title_sort early mortality in patients with muscle-invasive bladder cancer undergoing cystectomy in the united states
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349610/
https://www.ncbi.nlm.nih.gov/pubmed/30734024
http://dx.doi.org/10.1093/jncics/pky075
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