Perioperative Complications and Oncologic Outcomes after Radical Cystectomy in End-Stage Renal Disease Patients with Bladder Cancer Obtained Using a Standardized Reporting System
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Study Population
2.2. Pathological Evaluation
2.3. Outcome Measures
2.4. Statistical Analysis
3. Results
3.1. Study Population
3.2. Pathological Features
3.3. Postoperative Complications
3.4. Predictive Probability of Major Complications
3.5. Recurrence and Survival
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total (n = 141) | No Major Complication (Clavien 0–2, n = 99) | Major Complication (Clavien 3–5, n = 42) | p Value | |
---|---|---|---|---|
Gender | 0.348 | |||
Female | 84 (59.6) | 56 (56.6) | 28 (66.7) | |
Male | 57 (40.4) | 43 (43.4) | 14 (33.3) | |
Age, years, median (range) | 64 (24–86) | 63 (24–86) | 70 (50–83) | 0.010 0.062 |
<60 | 56 (39.7) | 45 (45.5) | 11 (26.2) | |
60–70 | 33 (23.4) | 23 (23.2) | 10 (23.8) | |
>70 | 52 (36.9) | 31 (31.3) | 21 (50.0) | |
BMI, kg/m2, median (range) | 23.0 (16.2–38.1) | 22.9 (17.5–38.1) | 23.3 (16.2–32.7) | 0.799 0.684 |
<25.0 | 98 (69.5) | 70 (70.7) | 28 (66.7) | |
≥25.0 | 40 (28.4) | 27 (27.3) | 13 (31.0) | |
Unknown | 3 (2.1) | 2 (2.0) | 1 (2.4) | |
CCI, median (range) a | 5 (3–9) | 4 (3–9) | 5 (4–9) | 0.003 0.002 |
≤4 | 62 (44.0) | 52 (52.5) | 10 (23.8) | |
≥5 | 79 (56.0) | 47 (47.5) | 32 (76.2) | |
Previous abdominal surgery | 73 (51.8) | 52 (52.5) | 21 (50.0) | 0.855 |
Renal replacement therapy | 0.984 | |||
Hemodialysis | 119 (84.4) | 84 (84.8) | 35 (83.3) | |
Peritoneal dialysis | 15 (10.6) | 10 (10.1) | 5 (11.9) | |
Kidney transplantation | 4 (2.8) | 3 (3.0) | 1 (2.4) | |
None | 3 (2.1) | 2 (2.0) | 1 (2.4) | |
Dialysis duration, years | 0.646 | |||
<5 | 67 (47.5) | 45 (45.5) | 22 (52.4) | |
5–10 | 41 (29.1) | 31 (31.3) | 10 (23.8) | |
>10 | 33 (23.4) | 23 (23.2) | 10 (23.8) | |
Hemoglobin, g/dL, median (range) a | 10.1 (6.0–15.7) | 10.1 (6.8–15.7) | 10.2 (6.0–12.7) | 0.540 1.000 |
≤10.1 | 72 (51.1) | 51 (51.5) | 21 (50.0) | |
>10.1 | 69 (48.9) | 48 (48.5) | 21 (50.0) | |
Potassium, mEq/L, median (range) b | 4.2 (2.7–6.8) | 4.2 (2.7–6.8) | 4.3 (3.3–5.7) | 0.815 0.090 |
<3.6 | 13 (9.2) | 12 (12.1) | 1 (2.4) | |
3.6–5.0 | 86 (61.0) | 56 (56.6) | 30 (71.4) | |
>5.0 | 19 (13.5) | 15 (15.2) | 4 (9.5) | |
Unknown | 23 (16.3) | 16 (16.2) | 7 (16.7) | |
Cystectomy year | 0.547 | |||
2004–2007 | 47 (33.3) | 34 (34.3) | 13 (31.0) | |
2008–2011 | 43 (30.5) | 32 (32.3) | 11 (26.2) | |
2012–2015 | 51 (36.2) | 33 (33.3) | 18 (42.9) | |
ASA score, median (range) | 3 (1–4) | 3 (1–3) | 3 (2–4) | 0.235 0.387 |
1 | 1 (0.7) | 1 (1.0) | 0 (0) | |
2 | 9 (6.4) | 7 (7.1) | 2 (4.8) | |
3 | 130 (92.2) | 91 (91.9) | 39 (92.9) | |
4 | 1 (0.7) | 0 (0) | 1 (2.4) | |
Surgeon volume, median (range) | 3 (1–27) | 0.003 | ||
Low, <9 cases | 62 (44.0) | 35 (35.4) | 27 (64.3) | |
High, ≥9 cases | 79 (56.0) | 64 (64.6) | 15 (35.7) | |
Operative methods | 0.839 | |||
Open | 101 (71.6) | 70 (70.7) | 31 (73.8) | |
Laparoscopic | 40 (28.4) | 29 (29.3) | 11 (26.2) | |
Operative time, min, median (range) a | 343 (68–676) | 337 (68–660) | 351 (213–676) | 0.280 0.715 |
≤343 | 71 (50.4) | 51 (51.5) | 20 (47.6) | |
>343 | 70 (49.6) | 48 (48.5) | 22 (52.4) | |
Blood loss, mL, median (range) a | 600 (50–8600) | 600 (50–6000) | 600 (100–8600) | 0.237 1.000 |
<600 | 68 (48.2) | 48 (48.5) | 20 (47.6) | |
≥600 | 72 (51.1) | 50 (50.5) | 22 (52.4) | |
Unknown | 1 (0.7) | 1 (1.0) | 0 (0) | |
Hospitalization, day, median (range) | 9 (2–145) | 9 (4–52) | 14 (2–145) | <0.001 |
Total (n = 141) | No Major Complication (Clavien 0–2, n = 99) | Major Complication (Clavien 3–5, n = 42) | p Value | |
---|---|---|---|---|
Pathological tumor stage | 0.372 | |||
0a/0is | 26 (18.4) | 18 (18.2) | 8 (19.0) | |
I | 37 (26.2) | 27 (27.3) | 10 (23.8) | |
II | 13 (9.2) | 8 (8.1) | 5 (11.9) | |
III | 9 (6.4) | 4 (4.0) | 5 (11.9) | |
IV | 4 (2.8) | 2 (2.0) | 2 (4.8) | |
No residual tumor | 52 (36.9) | 40 (40.4) | 12 (28.6) | |
Tumor grade a | 1.000 | |||
Low | 5 (5.6) | 3 (5.1) | 2 (6.7) | |
High | 84 (94.4) | 56 (94.9) | 28 (93.3) | |
Lymphovascular invasion | 0.065 | |||
Absent | 131 (92.9) | 95 (96.0) | 36 (85.7) | |
Present | 10 (7.1) | 4 (4.0) | 6 (14.3) | |
Surgical margin | 1.000 | |||
Negative | 136 (96.5) | 95 (96.0) | 41 (97.6) | |
Positive | 5 (3.5) | 4 (4.0) | 1 (2.4) | |
Concomitant carcinoma in situ | 0.755 | |||
Absent | 128 (90.8) | 89 (89.9) | 39 (92.9) | |
Present | 13 (9.2) | 10 (10.1) | 3 (7.1) |
Grade 0 | 25 (17.7) |
Grade 1 | 25 (17.7) |
Grade 2 | 49 (34.8) |
Pharmacological treatment other than grade 1 | 25 (17.7) |
Blood transfusion | 18 (12.8) |
Total parenteral nutrition | 6 (4.3) |
Grade 3 | 29 (20.6) |
Surgical intervention | 24 (17.0) |
arteriovenous shunt dysfunction | 10 (7.1) |
rectovaginal or vaginal fistula | 3 (2.1) |
infection | 3 (2.1) |
wound dehiscence | 2 (1.4) |
spleen laceration or splenectomy | 2 (1.4) |
bowel perforation | 2 (1.4) |
vaginal bleeding | 1 (0.7) |
ischemic leg | 1 (0.7) |
Radiological intervention | 4 (2.8) |
Endoscopic intervention | 1 (0.7) |
Grade 4 | 6 (4.3) |
Life-threatening single organ dysfunction | 5 (3.5) |
Life-threatening multiorgan dysfunction | 1 (0.7) |
Grade 5, death | 7 (5.0) |
Univariate | Multivariate | |||
---|---|---|---|---|
OR (95% CI) | p Value | OR (95% CI) | p Value | |
Male gender (referent: female) | 0.65 (0.31–1.39) | 0.265 | ||
Age (referent: < 60 years) | 0.068 | 0.213 | ||
60–70 | 1.78 (0.66–4.80) | 0.256 | 1.72 (0.58–5.12) | 0.332 |
>70 | 2.77 (1.17–6.56) | 0.020 | 2.31 (0.91–5.90) | 0.079 |
BMI ≥ 25 kg/m2 (referent: <25 kg/m2) | 1.20 (0.54–2.66) | 0.647 | ||
CCI ≥ 5 (referent: ≤4) a | 3.54 (1.57–7.98) | 0.002 | 3.43 (1.43–8.23) | 0.006 |
Previous abdominal surgery (referent: absent) | 0.90 (0.44–1.86) | 0.784 | ||
RRT (referent: hemodialysis) | 0.932 | |||
Kidney transplantation | 0.80 (0.08–7.96) | 0.849 | ||
Peritoneal dialysis | 1.20 (0.38–3.77) | 0.755 | ||
Dialysis duration (referent: <5 years) | 0.648 | |||
5–10 years | 0.66 (0.28–1.59) | 0.352 | ||
>10 years | 0.88 (0.36–2.19) | 0.799 | ||
Hemoglobin ≤ 10.1 g/dL (referent: >10.1 g/dL) a | 0.94 (0.46–1.94) | 0.869 | ||
Potassium (referent: 3.6–5.0 mEq/L) b | 0.130 | |||
<3.6 | 0.16 (0.02–1.26) | 0.081 | ||
>5.0 | 0.50 (0.15–1.63) | 0.250 | ||
Cystectomy year (referent: 2004–2007) | 0.549 | |||
2008–2011 | 0.90 (0.35–2.29) | 0.824 | ||
2012–2015 | 1.43 (0.60–3.37) | 0.418 | ||
ASA score ≥ 3 (referent: ASA ≤ 2) | 1.76 (0.36–8.65) | 0.488 | ||
Low-volume surgeon (referent: ≥ 9 cases) c | 3.29 (1.55–6.99) | 0.002 | 3.29 (1.46–7.40) | 0.004 |
Open method (referent: laparoscopy) | 1.17 (0.52–2.63) | 0.709 | ||
Operative time > 343 min (referent: ≤ 343 min) a | 1.17 (0.57–2.41) | 0.672 | ||
Blood loss ≥ 600 mL (referent: <600 mL) a | 1.06 (0.51–2.18) | 0.883 | ||
Stage 3/4 (referent: stage ≤ 2) | 3.10 (0.97–9.87) | 0.055 | ||
Tumor grade (referent: low grade) | 0.75 (0.12–4.75) | 0.760 | ||
Lymphovascular invasion (referent: absent) | 3.96 (1.06–14.8) | 0.041 | 3.46 (0.81–14.8) | 0.094 |
Surgical margin (referent: negative) | 0.58 (0.06–5.34) | 0.630 | ||
CIS (referent: absent) | 0.69 (0.18–2.63) | 0.581 |
Overall Survival | Cancer-Specific Survival | Recurrence-Free Survival | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate | Multivariate | Univariate | Multivariate | Univariate | Multivariate | |||||||
HR (95% CI) | p Value | HR (95% CI) | p Value | HR (95% CI) | p Value | HR (95% CI) | p Value | HR (95% CI) | p Value | HR (95% CI) | p Value | |
Male gender (referent: female) | 2.09 (1.10–3.95) | 0.024 | 2.36 (1.15–4.83) | 0.019 | 2.49 (0.56–11.1) | 0.233 | 1.95 (0.71–5.38) | 0.198 | ||||
Age (referent: <60 years) | <0.001 | 0.023 | 0.965 | 0.299 | ||||||||
60–70 years | 1.60 (0.57–4.46) | 0.372 | 1.27 (0.44–3.65) | 0.659 | 0 (0–1000) | 0.971 | 0.26 (0.03–2.13) | 0.210 | ||||
>70 years | 4.48 (2.06–9.74) | <0.001 | 2.91 (1.29–6.60) | 0.010 | 1.22 (0.27–5.50) | 0.792 | 1.36 (0.48–3.90) | 0.564 | ||||
BMI ≥ 25 kg/m2 (referent: <25 kg/m2) | 0.68 (0.31–1.49) | 0.338 | 0.40 (0.05–3.32) | 0.396 | 0.83 (0.26–2.60) | 0.744 | ||||||
CCI ≥ 5 (referent: ≤4) a | 4.30 (1.89–9.79) | 0.001 | 4.03 (1.54–10.5) | 0.004 | 2.26 (0.44–11.7) | 0.329 | 2.35 (0.75–7.39) | 0.143 | ||||
Previous abdominal surgery (referent: absent) | 0.80 (0.42–1.51) | 0.484 | 2.23 (0.43–11.5) | 0.339 | 1.29 (0.46–3.62) | 0.633 | ||||||
RRT (referent: hemodialysis) | 0.438 | 0.214 | 0.039 | 0.102 | ||||||||
Kidney transplantation | 2.10 (0.50–8.79) | 0.311 | 6.80 (0.79–58.3) | 0.080 | 7.19 (1.57–32.8) | 0.011 | 6.75 (1.09–41.7) | 0.040 | ||||
Peritoneal dialysis | 0.65 (0.20–2.12) | 0.473 | 1.64 (0.19–14.1) | 0.650 | 1.49 (0.33–6.80) | 0.609 | 0.97 (0.16–5.97) | 0.972 | ||||
Dialysis duration (referent: <5 years) | 0.356 | 0.713 | 0.597 | |||||||||
5–10 years | 0.72 (0.34–1.52) | 0.385 | 1.39 (0.28–6.90) | 0.685 | 0.93 (0.31–2.85) | 0.902 | ||||||
>10 years | 0.56 (0.24–1.31) | 0.179 | 0.55 (0.06–5.25) | 0.599 | 0.45 (0.10–2.13) | 0.316 | ||||||
Hemoglobin ≤ 10.1 g/dL (referent: >10.1 g/dL) a | 0.86 (0.45–1.63) | 0.638 | 1.33 (0.30–5.94) | 0.709 | 1.49 (0.53–4.19) | 0.450 | ||||||
Potassium (referent: 3.6–5.0 mEq/L) b | 0.906 | 0.684 | 0.978 | |||||||||
<3.6 | 1.18 (0.41–3.45) | 0.758 | 0.989 | 0.981 | ||||||||
>5.0 | 0.86 (0.30–2.52) | 0.789 | 2.13 (0.39–11.6) | 0.383 | 0.85 (0.19–3.84) | 0.834 | ||||||
Cystectomy year (referent: 2004–2007) | 0.909 | 0.496 | 0.846 | |||||||||
2008–2011 | 1.12 (0.53–2.38) | 0.765 | 3.56 (0.37–34.2) | 0.272 | 0.89 (0.24–3.32) | 0.862 | ||||||
2012–2015 | 1.20 (0.51–2.81) | 0.676 | 3.64 (0.38–35.1) | 0.265 | 1.27 (0.39–4.21) | 0.693 | ||||||
ASA score ≥ 3 (referent: ASA ≤ 2) | 0.68 (0.27–1.76) | 0.431 | 0.23 (0.04–1.18) | 0.077 | 0.54 (0.12–2.40) | 0.419 | ||||||
Low surgeon volume (referent: ≥9 cases) c | 1.96 (1.03–3.75) | 0.042 | 1.26 (0.58–2.71) | 0.562 | 1.91 (0.43–8.55) | 0.397 | 2.22 (0.79–6.23) | 0.132 | ||||
Open method (referent: laparoscopic) | 1.60 (0.73–3.49) | 0.237 | 2.66 (0.32–22.1) | 0.366 | 1.73 (0.49–6.12) | 0.399 | ||||||
Operative time > 343 min (referent: ≤343 min) a | 0.79 (0.42–1.51) | 0.480 | 0.15 (0.02–1.25) | 0.080 | 1.13 (0.41–3.11) | 0.817 | ||||||
Blood loss ≥ 600 mL (referent: <600 mL) a | 1.73 (0.90–3.35) | 0.103 | 2.44 (0.47–12.6) | 0.288 | 2.78 (0.88–8.72) | 0.080 | ||||||
Stage 3/4 (referent: stage ≤ 2) | 5.54 (2.37–12.9) | <0.001 | 37.2 (6.44–215) | <0.001 | 9.12 (1.73–48.0) | 0.009 | 6.61 (1.04–42.1) | 0.046 | 20.0 (7.00–56.9) | <0.001 | 3.78 (0.51–28.2) | 0.196 |
Tumor grade (referent: low grade) | 0.62 (0.34–1.13) | 0.117 | 0.37 (0.04–3.07) | 0.357 | 0.26 (0.06–1.16) | 0.077 | ||||||
Lymphovascular invasion (referent: absent) | 4.17 (1.60–10.9) | 0.004 | 0.10 (0.01–0.76) | 0.026 | 4.18 (0.50–35.2) | 0.188 | 20.6 (7.12–59.6) | <0.001 | 4.42 (0.50–38.7) | 0.180 | ||
Surgical margin (referent: negative) | 8.06 (2.30–28.2) | 0.001 | 1.97 (0.37–10.5) | 0.425 | 19.2 (1.85–200) | 0.013 | 8.90 (0.61–128) | 0.109 | 21.0 (6.20–71.4) | <0.001 | 4.59 (0.65–32.6) | 0.128 |
CIS (referent: absent) | 0.73 (0.22–2.38) | 0.603 | 1.40 (0.17–11.6) | 0.758 | 0.66 (0.09–5.02) | 0.687 | ||||||
Clavien grade 3–5 (referent: 0–2) | 3.43 (1.80–6.53) | <0.001 | 3.58 (1.61–7.95) | 0.002 | 0.44 (0.05–3.64) | 0.444 | 1.49 (0.51–4.36) | 0.469 |
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Liu, Y.-L.; Wu, C.-T.; Hsu, Y.-C.; Chen, M.-F.; Chen, C.-S.; Shi, C.-S.; Huang, Y.-C. Perioperative Complications and Oncologic Outcomes after Radical Cystectomy in End-Stage Renal Disease Patients with Bladder Cancer Obtained Using a Standardized Reporting System. Cancers 2022, 14, 3512. https://doi.org/10.3390/cancers14143512
Liu Y-L, Wu C-T, Hsu Y-C, Chen M-F, Chen C-S, Shi C-S, Huang Y-C. Perioperative Complications and Oncologic Outcomes after Radical Cystectomy in End-Stage Renal Disease Patients with Bladder Cancer Obtained Using a Standardized Reporting System. Cancers. 2022; 14(14):3512. https://doi.org/10.3390/cancers14143512
Chicago/Turabian StyleLiu, Yu-Liang, Chun-Te Wu, Yu-Chao Hsu, Miao-Fen Chen, Chih-Shou Chen, Chung-Sheng Shi, and Yun-Ching Huang. 2022. "Perioperative Complications and Oncologic Outcomes after Radical Cystectomy in End-Stage Renal Disease Patients with Bladder Cancer Obtained Using a Standardized Reporting System" Cancers 14, no. 14: 3512. https://doi.org/10.3390/cancers14143512
APA StyleLiu, Y.-L., Wu, C.-T., Hsu, Y.-C., Chen, M.-F., Chen, C.-S., Shi, C.-S., & Huang, Y.-C. (2022). Perioperative Complications and Oncologic Outcomes after Radical Cystectomy in End-Stage Renal Disease Patients with Bladder Cancer Obtained Using a Standardized Reporting System. Cancers, 14(14), 3512. https://doi.org/10.3390/cancers14143512