Comparative Performance of Comorbidity Indices for Estimating Perioperative and 5-Year All-Cause Mortality Following Radical Cystectomy for Bladder Cancer
Boorjian SA, Kim SP, Tollefson MK, Carrasco A, Cheville JC, Thompson RH, Thapa P, Frank I. J Urol. 2013 Jan 9. pii: S0022-5347(13)00026-8. doi: 10.1016/j.juro.2013.01.010. [Epub ahead of print]

Source

Department of Urology, Mayo Clinic, Rochester, Minnesota. Electronic address: boorjian.stephen@mayo.edu.

Abstract

PURPOSE:

Radical cystectomy (RC) continues to be associated with a non-negligible risk of perioperative death, while all-cause mortality (ACM) in the years after surgery remains relatively high as well. We investigated the comparative ability of various comorbidity indices to predict perioperative and 5-year ACM following RC.

MATERIALS AND METHODS:

We evaluated 891 patients who underwent RC between 1994-2005. The associations of American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI), Elixhauser index (EI), and Eastern Cooperative Oncology Group performance status (ECOG) with outcomes were assessed using Cox regression models. Model performance was compared with area under receiver operating curves (AUC).

RESULTS:

A total of 33 (3.7%) patients died within 90 days of RC. On multivariate analysis, locally-advanced pathologic tumor stage (HR 4.86;p=0.002), as well as EI (HR 1.48;p=0.002), ASA (HR 3.17;p=0.001), and ECOG (HR 2.40;p<0.0001) were significantly associated with 90-day perioperative mortality. Median follow-up after RC was 10.1 years, during which time 576 patients died. CCI (HR 1.23;p<0.0001), EI (HR 1.28;p<0.0001), ASA (HR1.44;p=0.007), and ECOG (HR 1.97;p<0.0001) were independent predictors of 5-year ACM. Moreover, CCI (AUC 0.798;p<0.0001), EI (AUC 0.770;p=0.03), and ECOG (AUC 0.769;p=0.03) significantly enhanced the performance of a base model which did not include comorbidity status (AUC 0.757) to predict 5-year ACM.

CONCLUSIONS:

Comorbidity status is predictive of perioperative death and 5-year ACM following RC, and should therefore be incorporated into patient counseling and risk stratification models. Further prospective studies are warranted to overcome the retrospective limitations in determining the relative prognostic value of various comorbidity indices.