title: Predicting the probability of 90-day survival of elderly patients with bladder cancer treated with radical cystectomy.
abstract: OBJECTIVE
  Despite the increased morbidity and mortality of radical cystectomy in elderly individuals with bladder cancer numerous studies show that surgery can provide a survival benefit. We sought to better identify patients at substantial risk for postoperative mortality.
  
  
  METHODS
  We evaluated 220 consecutive patients 75 years old or older treated with radical cystectomy for bladder cancer at a single institution from 2000 to 2008. The analytical cohort comprised 169 patients with complete preoperative data available. A Cox proportional hazards model was used to determine the value of precystectomy clinical information to predict 90-day survival after radical cystectomy. Results were used to create a nomogram predicting the probability of 90-day survival after radical cystectomy. The model was then subjected to 200 bootstrap resamples for internal validation.
  
  
  RESULTS
  Of the 220 patients 28 (12.7%) died within 90 days of surgery. Older age (HR 2.30, 95% CI 1.22-4.32) and lower preoperative albumin (HR 2.50, 95% CI 1.40-4.45) were significant predictors of 90-day mortality. We developed a nomogram based on patient age, clinical stage, Charlson comorbidity index and albumin to predict the likelihood of 90-day mortality with 75% accuracy. Internal validation showed a bootstrap adjusted concordance index of 71%.
  
  
  CONCLUSIONS
  We developed a nomogram that provides individualized risk estimations to predict the probability of 90-day mortality, potentially enhancing preoperative counseling and providing clinicians with an added tool to individualize treatment decisions in this challenging patient population. These data suggest that albumin is a strong predictor of postoperative mortality and show the importance of assessing this variable before surgery.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37215, USA. todd.morgan@vanderbilt.edu
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Keegan
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.forename: Nedim
authors.initials: N
authors.lastname: Ruhotina
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Phillips
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*