title: Use of preoperative performance status and hemoglobin concentration to predict overall survival for patients aged ≥ 75 years after radical cystectomy for treatment of bladder cancer.
abstract: BACKGROUND
  The standard of care for treatment of localized muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC). The patient's condition may affect management of MIBC, especially for elderly patients with more comorbid conditions and lower performance status. We retrospectively evaluated the association between clinicopathological data and outcomes for patients with bladder cancer (BCa) treated by RC. We particularly focused on elderly patients (age ≥75 years) with BCa.
  
  
  METHODS
  We enrolled 254 patients with BCa who underwent RC and urinary diversion with or without pelvic lymph node dissection. We assessed perioperative complications and clinicopathological data affecting overall survival (OS) after RC.
  
  
  RESULTS
  The incidence of complications was 34.3 %, and that of severe complications (Grade 3-5) was 16.5 %. The elderly group experienced more severe complications (P = 0.042). Median follow-up was 43.0 months (range 1.0-155.6). Five-year OS after RC was 62.7 %. OS after RC was no different for patients aged ≥75 and <75 years (P = 0.983). Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status (ECOG PS) and hemoglobin (Hb) concentration were associated with all-cause mortality. Hb concentration of <12.6 g/dl was an independent predictor of a poor prognosis among elderly patients after RC for BCa. ECOG PS >1 tended to affect OS after RC in this group.
  
  
  CONCLUSIONS
  ECOG PS and preoperative Hb concentration were useful for prediction of clinical outcome after RC for elderly patients. This information may aid decision-making in the treatment of elderly patients with MIBC.
authors.affiliation: Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan. hara-t@masuda.jrc.or.jp.|Department of Urology, Masuda Red Cross Hospital, I 103-1 Otoyoshi-chou, Masuda, Shimane, 698-8501, Japan. hara-t@masuda.jrc.or.jp.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Hara
authors.affiliation: Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Matsuyama
authors.affiliation: Department of Urology, Shimonoseki Saisekai Toyoura Hospital, 7-3 Kogushi, Toyoura, Shiomonoseki, Yamaguchi, 759-6302, Japan.
authors.forename: Yoriaki
authors.initials: Y
authors.lastname: Kamiryo
authors.affiliation: Department of Urology and Nephrology, Tokuyama Central Hospital, 1-1 Takada, Shunan, Yamaguchi, 745-8522, Japan.
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Hayashida
authors.affiliation: Department of Urology, Tokuyama Medical Association Hospital, 6-28 Higashiyama, Shunan, Yamaguchi, 745-0846, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Urology and Nephrology, Tokuyama Central Hospital, 1-1 Takada, Shunan, Yamaguchi, 745-8522, Japan.
authors.forename: Takahito
authors.initials: T
authors.lastname: Nasu
authors.affiliation: Department of Urology, Saiseikai Yamaguchi General Hospital, 2-11 Midorimachi, Yamaguchi, Yamaguchi, 753-0078, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Joko
authors.affiliation: Department of Urology, Shuto General Hospital, 1000-1 Kokaisaku, Yanai, Yamaguchi, 742-0032, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Baba
authors.affiliation: Department of Urology, Yamaguchi Red Cross Hospital, 53-1 Hachimanbaba, Yamaguchi, Yamaguchi, 753-8519, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Suga
authors.affiliation: Department of Urology, Yamaguchi Grand Medical Center, Hofu, 77 Osaki, Yamaguchi, 747-8511, Japan.
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Masuda Red Cross Hospital, I 103-1 Otoyoshi-chou, Masuda, Shimane, 698-8501, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Aoki
authors.affiliation: Department of Urology, Saiseikai Shimonoseki General Hospital, 8-5-1 Yasuoka, Shomonoseki, Yamaguchi, 759-6603, Japan.
authors.forename: Kimio
authors.initials: K
authors.lastname: Takai
authors.affiliation: Department of Urology, Shimonoseki City Hospital, 1-13-1 Koyo, Shimonoseki, Yamaguchi, 750-8520, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Yoshihiro
authors.affiliation: Department of Urology, Shunan City Shinnanyo Hospital, 2-3-15 Miyanomae, Syunan, Yamaguchi, 746-0017, Japan.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Konishi
authors.affiliation: Department of Urology, Kokura Memorial Hospital, 3-2-1 Asano, Kokura-ku, Kitakyusyu, Fukuoka, 802-8555, Japan.
authors.forename: Sigeru
authors.initials: S
authors.lastname: Sakano
authors.affiliation: Department of Urology, Hikari Municipal Hikari General Hospital, 2-10-1 Nijigahama, Hikari, Yamaguchi, 743-0022, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Imoto
authors.affiliation: Department of Urology, Kanmon Medical Center, 1-1-1 Chofusotoura-cho, Shimonoseki, Yamaguchi, 752-8510, Japan.
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Tei
authors.affiliation: Department of Urology, Shimonoseki Medical Center, 3-3-8 Kamishinchi-cho, Shimonoseki, Yamaguchi, 750-0061, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Yamaguchi
authors.affiliation: Department of Urology, Ogori Daiichi General Hospital, 862-3 Ogori Shimogo, Yamaguchi, Yamaguchi, 754-0002, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Yano
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion
chemical_list: D006454:Hemoglobins
keywords: Bladder cancer; Overall survival; Patient selection; Radical cystectomy