title: Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort.
abstract: BACKGROUND
  Despite recent improvements, radical cystectomy (RC) is still associated with adverse rates for 90-d mortality.
  
  
  OBJECTIVE
  To validate the performance of the Isbarn nomogram incorporating age and postoperative tumor characteristics for predicting 90-d RC mortality in a multicenter series and to generate a new nomogram based strictly on preoperative parameters.
  
  
  METHODS
  Data of 679 bladder cancer (BCa) patients treated with RC at 18 institutions in 2011 were prospectively collected, from which 597 patients were eligible for final analysis.
  
  
  METHODS
  RC for BCa.
  
  
  METHODS
  An established prediction tool, the Isbarn nomogram, was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver operating characteristics-derived area under the curve. Calibration plots examined the relationship between predicted and observed probabilities. Univariable and multivariable logistic regression models were fitted to assess the impact of preoperative characteristics on 90-d mortality.
  
  
  CONCLUSIONS
  The 30-, 60-, and 90-d mortality rates in the development cohort (n=597) were 2.7%, 6.7%, and 9.0%, respectively. The Isbarn nomogram predicted individual 90-d mortality with an accuracy of 68.6%. Our preoperative multivariable model identified age (odds ratio [OR]:1.052), American Society of Anesthesiologists score (OR: 2.274), hospital volume (OR: 0.982), clinically lymphatic metastases (OR: 4.111), and clinically distant metastases (OR: 7.788) (all p<0.05) as independent predictors of 90-d mortality (predictive accuracy: 78.8%). Our conclusions are limited by the lack of an external validation of the preoperative model.
  
  
  CONCLUSIONS
  The Isbarn nomogram was validated with moderate discrimination. Our newly developed model consisting of preoperative characteristics might outperform existing models. Our model might be particularly suitable for preoperative patient counseling.
  
  
  RESULTS
  The current report validated an established nomogram predicting 90-d mortality in patients with bladder cancer after radical cystectomy (RC). We developed a new prediction tool consisting of strictly preoperative parameters, thus allowing clinicians an optimal consultation for RC candidates.
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany. Electronic address: atiqullah.aziz@ukr.de.
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.affiliation: Department of Urology, St. Elisabeth Medical Center, Straubing, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Urology, Marienhospital, Ruhr-University Bochum, Herne, Germany.
authors.forename: Rein-Jüri
authors.initials: RJ
authors.lastname: Palisaar
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Chun
authors.affiliation: Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Martini
authors.affiliation: Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.affiliation: Department of Urology, Central Hospital of Bolzano, Bolzano, Italy.
authors.forename: Roman
authors.initials: R
authors.lastname: Mayr
authors.affiliation: Department of Urology, Central Hospital of Bolzano, Bolzano, Italy.
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Nuhn
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Dresden University of Technology, Dresden, Germany.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novotny
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Dresden University of Technology, Dresden, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Wirth
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.affiliation: Department of Urology, Marienhospital, Ruhr-University Bochum, Herne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.affiliation: Department of Urology, St. Elisabeth Medical Center, Straubing, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Gilfrich
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-May
authors.affiliation: Department of Urology, Paracelsus Medical Center Golzheim, Düsseldorf, Germany.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gierth
authors.affiliation: Department of Urology, Marienhospital, Ruhr-University Bochum, Herne, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
mesh_terms: D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D002278:Carcinoma in Situ / Q000401:mortality* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D015653:Cystectomy / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011336:Probability; D011446:Prospective Studies; D012372:ROC Curve; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery
keywords: 90-day mortality; Bladder cancer; Nomogram; Outcome; Radical cystectomy