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Development and Validation of a Reference Table for Prediction of Postoperative Mortality Rate in Patients Treated with Radical Cystectomy: A Population-based Study

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The existing literature suggests that the postoperative mortality (POM) rate in radical cystectomy (RC) patients does not exceed 3%. We sought to develop and externally validate a reference table that quantifies POM after RC.

Methods

We identified 12,274 patients treated with RC, between 1998 and 2007, within the Nationwide Inpatient Sample database. A total of 6188 (50.4%) randomly selected patients was used as the development cohort. Logistic regression analysis for prediction of POM adjusted for: age, sex, race, Charlson comorbidity index (CCI), urinary diversion type, year of surgery, annual hospital caseload, location/teaching status of hospital, region and bed size of hospital. The reference table was developed by using stepwise variable removal to identify the most accurate and parsimonious model. The model was externally validated in 6086 (49.6%) patients.

Results

POM occurred in 2.4% of patients. POM proportion increased with increasing age (≤59: 0.6% vs. 60–69: 1.6% vs. 70–79: 3.1% vs. ≥80: 4.6%, P < 0.001), and higher CCI (CCI 0: 1.7% vs. CCI 1: 3.0% vs. CCI 2: 4.2% vs. CCI 3: 4.3% vs. CCI ≥ 4: 12.1%, P < 0.001). In multivariable analyses, only age and CCI remained as independent predictors of POM, after stepwise variable removal. The discrimination accuracy of the reference table in predicting POM was 70%.

Conclusions

Age and CCI represent the foremost determinants of POM after RC. The developed reference table is capable of predicting POM after RC, in an individualized fashion. The accuracy of the model is good (70%), and it is highly generalizable.

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References

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  2. NCCCN clinical practice guidelines in oncology: bladder cancer, 2010. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed August 2010.

  3. Clark PE, Stein JP, Groshen SG, et al. Radical cystectomy in the elderly: comparison of clinical outcomes between younger and older patients. Cancer. 2005;104:36–43.

    Article  PubMed  Google Scholar 

  4. Elting LS, Pettaway C, Bekele BN, et al. Correlation between annual volume of cystectomy, professional staffing, and outcomes: a statewide, population-based study. Cancer. 2005;104:975–84.

    Article  PubMed  Google Scholar 

  5. Figueroa AJ, Stein JP, Dickinson M, et al. Radical cystectomy for elderly patients with bladder carcinoma: an updated experience with 404 patients. Cancer. 1998;83:141–7.

    Article  PubMed  CAS  Google Scholar 

  6. Knap MM, Lundbeck F, Overgaard J. Early and late treatment-related morbidity following radical cystectomy. Scand J Urol Nephrol. 2004;38:153–60.

    Article  PubMed  Google Scholar 

  7. Konety BR, Allareddy V, Herr H. Complications after radical cystectomy: analysis of population-based data. Urology. 2006;68:58–64.

    Article  PubMed  Google Scholar 

  8. Konety BR, Dhawan V, Allareddy V, Joslyn SA. Impact of hospital and surgeon volume on in-hospital mortality from radical cystectomy: data from the health care utilization project. J Urol. 2005;173:1695–700.

    Article  PubMed  Google Scholar 

  9. Rosario DJ, Becker M, Anderson JB. The changing pattern of mortality and morbidity from radical cystectomy. BJU Int. 2000;85:427–30.

    Article  PubMed  CAS  Google Scholar 

  10. Stein JP, Lieskovsky G, Cote R, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19:666–75.

    PubMed  CAS  Google Scholar 

  11. Overview of the Nationwide Inpatient Sample (NIS). http://www.hcup-us.ahrq.gov/nisoverview.jsp#Whatis. Accessed August 2010.

  12. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.

    Article  PubMed  CAS  Google Scholar 

  13. Ross TD. Accurate confidence intervals for binomial proportion and Poisson rate estimation. Comput Biol Med. 2003;33:509–31.

    Article  PubMed  Google Scholar 

  14. Harrell FE Jr, Califf RM, Pryor DB, et al. Evaluating the yield of medical tests. JAMA. 1982;247:2543–6.

    Article  PubMed  Google Scholar 

  15. Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.

    Article  PubMed  Google Scholar 

  16. Gore JL, Litwin MS, Lai J, et al. Use of radical cystectomy for patients with invasive bladder cancer. J Natl Cancer Inst. 2010;102:802–11.

    Article  PubMed  Google Scholar 

  17. Abdollah F, Sun M, Schmitges J, et al. Surgical caseload is an important determinant of continent urinary diversion rate at radical cystectomy: a population-based study. Ann Surg Oncol. doi:10.1245/s10434-011-1618-2.

  18. Gore JL, Yu HY, Setodji C, et al. Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer. 2010;116:331–9.

    Article  PubMed  Google Scholar 

  19. Konety BR, Allareddy V. Influence of post-cystectomy complications on cost and subsequent outcome. J Urol. 2007;177:280–7.

    Article  PubMed  Google Scholar 

  20. Alibhai SM, Leach M, Tomlinson G. Impact of hospital and surgeon volume on mortality and complications after prostatectomy. J Urol. 2008;180:155–62.

    Article  PubMed  Google Scholar 

  21. Yu JB, Makarov DV, Sharma R, et al. Validation of the partin nomogram for prostate cancer in a national sample. J Urol. 2010;183:105–11.

    Article  PubMed  Google Scholar 

  22. Briganti A, Chun FK, Salonia A, et al. Validation of a nomogram predicting the probability of lymph node invasion among patients undergoing radical prostatectomy and an extended pelvic lymphadenectomy. Eur Urol. 2006;49:1019–26.

    Article  PubMed  Google Scholar 

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Acknowledgment

P.I.K. is partially supported by the University of Montreal Health Center Fonds de la Recherche en Santé du Quebec, the University of Montreal Department of Surgery and the University of Montreal Health Center (CHUM) Foundation.

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Authors and Affiliations

  1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada

    Firas Abdollah MD, Maxine Sun BSc, Jan Schmitges MD, Rodolphe Thuret MD, Orchidee Djahangirian MD, Claudio Jeldres MD, Zhe Tian BSc, Paul Perrotte MD & Pierre I. Karakiewicz MD

  2. Department of Urology, Vita Salute San Raffaele University, Milan, Italy

    Firas Abdollah MD & Francesco Montorsi MD

  3. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany

    Jan Schmitges MD

  4. Department of Urology, Weill Medical College of Cornell University, New York, NY, USA

    Shahrokh F. Shariat MD

Authors
  1. Firas Abdollah MD
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  2. Maxine Sun BSc
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  3. Jan Schmitges MD
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  4. Rodolphe Thuret MD
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  5. Orchidee Djahangirian MD
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  6. Claudio Jeldres MD
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  7. Zhe Tian BSc
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  8. Shahrokh F. Shariat MD
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  9. Paul Perrotte MD
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  10. Francesco Montorsi MD
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  11. Pierre I. Karakiewicz MD
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Corresponding author

Correspondence to Maxine Sun BSc.

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The first two authors contributed equally to this work.

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Abdollah, F., Sun, M., Schmitges, J. et al. Development and Validation of a Reference Table for Prediction of Postoperative Mortality Rate in Patients Treated with Radical Cystectomy: A Population-based Study. Ann Surg Oncol 19, 309–317 (2012). https://doi.org/10.1245/s10434-011-1852-7

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  • DOI: https://doi.org/10.1245/s10434-011-1852-7

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