title: Significance of preoperative butyrylcholinesterase as an independent predictor of survival in patients with muscle-invasive bladder cancer treated with radical cystectomy.
abstract: OBJECTIVE
  Butyrylcholinesterase (BChE) is an alpha-glycoprotein found in the nervous system and liver. Its serum level is reduced in many clinical conditions, such as liver damage, inflammation, injury, infection, malnutrition, and malignant disease. In this study, we analyzed the potential prognostic significance of preoperative BChE levels in patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC).
  
  
  METHODS
  We retrospectively evaluated 327 patients with MIBC who underwent RC from 1996 to 2013 at a single institution. Serum BChE level was routinely measured before operation in all patients. Covariates included age, gender, preoperative laboratory data (anemia, BChE, lactate dehydrogenase, and C-reactive protein), clinical T (cT) and N stage (cN), tumor grade, and RC with/without neoadjuvant chemotherapy. Univariate and multivariate analyses were performed to identify clinical factors associated with overall survival (OS) and disease-free survival (DFS). Univariate analyses were performed using the Kaplan-Meier and log-rank methods, and the multivariate analysis was performed using a Cox proportional hazard model.
  
  
  RESULTS
  The median BChE level was 187 U/l (normal range: 168-470 U/l). The median age of the enrolled patients was 69 years, and the median follow-up period was 51 months. The 5-year OS and DFS rates were 69.6% and 69.3%, respectively. The 5-year OS rates were 90.1% and 51.3% in the BChE ≥ 168 and<168 U/l groups, respectively (P<0.001). The 5-year DFS rates were 83.5% and 55.4% in the BChE ≥ 168 and ≤167 U/l groups, respectively (P<0.001). In the univariate analysis, BChE, cT, cN, and RC with/without neoadjuvant chemotherapy were significantly associated with both OS and DFS. Multivariate analysis revealed that BChE was the factor most significantly associated with OS, and BChE, cT, and cN were significantly associated with DFS.
  
  
  CONCLUSIONS
  This study validated preoperative serum BChE levels as an independent prognostic factor for MIBC after RC.
authors.affiliation: Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan. Electronic address: goodwin@cc.hirosaki-u.ac.jp.
authors.forename: Takuya
authors.initials: T
authors.lastname: Koie
authors.affiliation: Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Ohyama
authors.affiliation: Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Hatakeyama
authors.affiliation: Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Imai
authors.affiliation: Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yoneyama
authors.affiliation: Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Anesthesiology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kitayam
authors.affiliation: Department of Anesthesiology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hirota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002091:Butyrylcholinesterase / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009132:Muscles / Q000473:pathology*; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
chemical_list: D002091:Butyrylcholinesterase
keywords: Biomarker; Butyrylcholinesterase; Disease-free survival; Muscle-invasive bladder cancer; Overall survival