Perioperative Mortality and Long-Term Survival after Radical Cystectomy: A Population-Based Study in a Southern European Country on 4,389 Patients
| Autor: | Angelo Porreca, Walter Artibani, Giovanni Cacciamani, Angela De Paoli, Ugo Fedeli, Inderbir S. Gill, Maria Chiara Corti, Filiberto Zattoni, Giacomo Novara |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Urology medicine.medical_treatment Population 030232 urology & nephrology Cystectomy Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine Epidemiology medicine Bladder cancer Cohort study Lymphadenectomy Radical cystectomy Urinary diversion Humans education Aged Cause of death Aged 80 and over education.field_of_study business.industry Proportional hazards model Odds ratio Perioperative Middle Aged Survival Rate Italy Urinary Bladder Neoplasms 030220 oncology & carcinogenesis Female business |
| Popis: | Purpose: Population-based data on survival after radical cystectomy (RC) are lacking from Southern Europe. The aim of this study was to assess trends and determinants of perioperative mortality and long-term survival in the Veneto region (Northeastern Italy). Methods: All patients submitted to RC for bladder cancer from January 2004 to December 2016 were identified from the regional archive of hospital discharge records. Age at surgery, gender, comorbidities, hospital volume, calendar period of surgery, and type of urinary diversion were retrieved; vital status and cause of death were obtained by linkage with mortality records. Determinants of 90-day mortality were assessed by multilevel logistic regression; long-term survival was investigated by the Kaplan-Meier method and Cox regression. Results: Among 4,389 included patients, an increase in the share of patients aged ≥80 years (from 13% in 2004–2008 to 24% in 2013–2016, p < 0.001) and a decline in performing continent diversion (from 34.9 to 23.4%, p < 0.001) were observed across the study period. Ninety-day mortality did not change over time and was 4% for patients aged 30 RCs/year (odds ratio 0.67, 95% confidence interval 0.48–0.93). At a median follow-up of 67 months, overall survival at 1 year and 5 years was 72 and 40%, respectively, with a higher rate among younger patients treated in high-volume hospitals. Conclusion: The population of patients treated with RC is rapidly ageing, with a high risk of perioperative and long-term mortality; this changing epidemiological scenario and better outcomes observed in high-volume hospitals support regionalization of the procedure. |
| Databáze: | OpenAIRE |
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