title: The association of preoperative serum albumin level and American Society of Anesthesiologists (ASA) score on early complications and survival of patients undergoing radical cystectomy for urothelial bladder cancer.
abstract: OBJECTIVE
  To evaluate the impact of the preoperative American Society of Anesthesiologists (ASA) score and serum albumin level on complications, recurrences and survival rates of patients who underwent radical cystectomy (RC) for urothelial bladder cancer (UBC).
  
  
  METHODS
  In all, 1964 patients underwent RC for UBC at our institution between 1971 and 2008. Preoperative serum albumin and ASA score were available in 1471 and 1140 patients, respectively. A complication was defined as any surgery related/unrelated event leading to lengthening hospital stay or re-admission. Endpoints were 90-day complication (90dC) rate, recurrence-free survival (RFS) and overall survival (OS).
  
  
  RESULTS
  The median (range) follow-up was 12.4 (0.2-27.3) years. In all, 197 patients (13.4%) had a low albumin level (<3.5 g/dL) and 740 (64.8%) had a high ASA score (3 or 4). Low serum albumin and a high ASA score were associated with higher 90dC rate (42% vs 34%, P = 0.03 and 40% vs 28%, P < 0.001, respectively). On multiple logistic regression analysis, a high ASA score remained independently associated with increased 90dC rate (hazard ratio [HR] 1.52, P = 0.005) and decreased OS (HR 1.45, 95% confidence interval [CI] 1.13-1.86). A low serum albumin level was also independently associated with RFS (HR 1.68, 95% CI 1.16-2.43) and OS (HR 1.93, 95% CI 1.43-2.63).
  
  
  CONCLUSIONS
  A low serum albumin level was independently associated with cancer recurrence and decreased OS after RC. A high ASA score was also independently associated with decreased OS. These parameters potentially could be used as prognosticators after RC.
authors.affiliation: Norris Comprehensive Cancer Center, University of Southern California Institute of Urology, Los Angeles, CA, USA.
authors.forename: Hooman
authors.initials: H
authors.lastname: Djaladat
authors.forename: Harman Maxim
authors.initials: HM
authors.lastname: Bruins
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D015653:Cystectomy / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D012955:Societies, Medical; D015996:Survival Rate; D013997:Time Factors; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000401:mortality* / Q000601:surgery
chemical_list: D012709:Serum Albumin
keywords: ASA score; cystectomy; serum albumin; urothelial carcinoma