title: Comorbidity and performance indices as predictors of cancer-independent mortality but not of cancer-specific mortality after radical cystectomy for urothelial carcinoma of the bladder.
abstract: BACKGROUND
  Comorbidity and performance indices allow assessment of preoperative health status. However, the optimal tool for use in patients with urothelial carcinoma of the bladder (UCB) who are undergoing radical cystectomy (RC) has not yet been established.
  
  
  OBJECTIVE
  To evaluate correlation of Adult Comorbidity Evaluation-27 (ACE27), Charlson Comorbidity Index, Age-Adjusted Charlson Comorbidity Index, Eastern Cooperative Oncology Group performance status, and American Society of Anesthesiologists (ASA) score with survival.
  
  
  METHODS
  A retrospective multicenter study was carried out on 555 unselected consecutive patients who underwent RC for UCB from 2000 to 2010.
  
  
  METHODS
  RC with pelvic lymph node dissection in patients with UCB without neoadjuvant chemotherapy.
  
  
  METHODS
  Cox regression models were calculated with established variables to assess predictive capacity for cancer-specific mortality (CSM) and cancer-independent mortality (CIM).
  
  
  CONCLUSIONS
  All indices were independent predictors for CIM but not for CSM. The ASA score was the only index that significantly increased the predictive accuracy of the predefined CIM model (+2.3%; p=0.045). To create a clinically valuable tool, we devised a weighted prognostic model including age and the best prognosticators within the performance and comorbidity scores (ASA/ACE27 0-1/2-3). A 3-yr CIM rate of 8%, 26%, and 47% was calculated for the low-, intermediate-, and high-risk groups, respectively. Patients >75 yr of age with ASA 3/4 and ACE27 >1 exhibited a CIM risk seven times greater than patients ≤75 yr with ASA 1/2 and ACE27 0/1. This study is limited by the short follow-up and its retrospective nature.
  
  
  CONCLUSIONS
  Comorbidity and performance assessment is mandatory in the preoperative prediction of CIM for patients undergoing RC for UCB. The present results indicate that the ASA score is the tool of choice. External and prospective validation is warranted.
authors.affiliation: Department of Urology, Central Hospital of Bolzano, Bolzano, Italy.
authors.forename: Roman
authors.initials: R
authors.lastname: Mayr
authors.forename: Mattias
authors.initials: M
authors.lastname: May
authors.forename: Thomas
authors.initials: T
authors.lastname: Martini
authors.forename: Michele
authors.initials: M
authors.lastname: Lodde
authors.forename: Evi
authors.initials: E
authors.lastname: Comploj
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Jenny
authors.initials: J
authors.lastname: Strobel
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Otto
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wieland
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality* / Q000601:surgery; D002423:Cause of Death; D015897:Comorbidity; D015653:Cystectomy / Q000379:methods / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery