title: Associations between comorbidity, and overall survival and bladder cancer specific survival after radical cystectomy: results from the Alberta Urology Institute Radical Cystectomy database.
abstract: OBJECTIVE
  We determined the associations between comorbidity, and overall survival and bladder cancer specific survival after radical cystectomy.
  
  
  METHODS
  The Alberta Urology Institute Radical Cystectomy database is an ongoing multi-institutional computerized database containing data on all adult patients with a diagnosis of primary bladder cancer treated with radical cystectomy in Edmonton, Canada from April 1994 forward. The current study is an analysis of consecutive database patients treated between April 1994 and September 2007. Comorbidity information was obtained through a medical record review using the Adult Comorbidity Evaluation 27 instrument. The outcome measures were overall survival and bladder cancer specific survival. Cox proportional regression analysis was used to determine the associations between comorbidity, and overall survival and bladder cancer specific survival.
  
  
  RESULTS
  Of the database patients 160 (34%), 225 (48%) and 83 (18%) had no/mild comorbidity, moderate comorbidity and severe comorbidity, respectively. Compared to patients with no or mild comorbidity, multivariate Cox proportional regression analyses that included age, adjuvant chemotherapy, surgeon procedure volume, pathological T stage, pathological lymph node status, total number of lymph nodes removed, surgical margin status and lymphovascular invasion showed that increased comorbidity was independently associated with overall survival (moderate HR 1.59, 95% CI 1.16-2.18, p = 0.004; severe HR 1.83, 95% CI 1.22-2.72, p = 0.003) and bladder cancer specific survival (moderate HR 1.50, 95% CI 1.04-2.15, p = 0.028; severe HR 1.65, 95% CI 1.04-2.62, p = 0.034).
  
  
  CONCLUSIONS
  Increased comorbidity was independently associated with an increased risk of overall mortality and bladder cancer specific mortality after radical cystectomy.
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. afairey@ualberta.ca
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Fairey
authors.forename: Niels-Erik B
authors.initials: NE
authors.lastname: Jacobsen
authors.forename: Michael P
authors.initials: MP
authors.lastname: Chetner
authors.forename: David R
authors.initials: DR
authors.lastname: Mador
authors.forename: James B
authors.initials: JB
authors.lastname: Metcalfe
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Moore
authors.forename: Keith F
authors.initials: KF
authors.lastname: Rourke
authors.forename: Gerald T
authors.initials: GT
authors.lastname: Todd
authors.forename: Peter M
authors.initials: PM
authors.lastname: Venner
authors.forename: Don C
authors.initials: DC
authors.lastname: Voaklander
authors.forename: Eric P
authors.initials: EP
authors.lastname: Estey
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D015653:Cystectomy / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012955:Societies, Medical; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*