title: The Charlson comorbidity index predicts survival after disease recurrence in patients following radical cystectomy for urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  To identify prognostic clinical and histopathological parameters, including comorbidity indices at the time of radical cystectomy (RC), for overall survival (OS) after recurrence following RC for urothelial carcinoma of the bladder (UCB).
  
  
  METHODS
  A retrospective multicenter study was carried out in 555 unselected consecutive patients who underwent RC with pelvic lymph node dissection for UCB from 2000 to 2010. A total of 227 patients with recurrence comprised our study group. Cox proportional hazards regression models were calculated with established variables to assess their independent influence on OS after recurrence.
  
  
  RESULTS
  The median time from RC to recurrence and the median OS after recurrence was 10.9 and 5.4 months, respectively. Neither the time to recurrence nor the type of recurrence (systematic vs. local) was predictive of the OS. In contrast, age (hazard ratio (HR) 1.53, p = 0.011), lymph node metastasis (HR 1.56, p = 0.007), and positive surgical margins (HR 1.53, p = 0.046) significantly affected the OS after disease recurrence. In addition, the dichotomized Charlson comorbidity index (CCI; dichotomized into >2 vs. 0-2) was the only comorbidity score with an independent prediction of OS (HR 1.41, p = 0.033). We observed a significant gain in the base model's predictive accuracy, i.e. from 68.4 to 70.3% (p < 0.001), after inclusion of the dichotomized CCI.
  
  
  CONCLUSIONS
  We present the first outcome study of comorbidity indices used as predictors of OS after disease recurrence in patients undergoing RC for UCB. The CCI at the time of RC had no significant influence on the time to recurrence but represented an independent predictor of OS after disease recurrence.
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Mayr
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Thomas
authors.initials: T
authors.lastname: Martini
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Christopher
authors.initials: C
authors.lastname: Dechet
authors.forename: Michele
authors.initials: M
authors.lastname: Lodde
authors.forename: Evi
authors.initials: E
authors.lastname: Comploj
authors.forename: Wolf F
authors.initials: WF
authors.lastname: Wieland
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Otto
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Michael
authors.initials: M
authors.lastname: Gierth
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*; D019459:Urothelium / Q000473:pathology*