The incidence of renal deterioration was comparatively high following radical cystectomy, irrespective of the type of UD. Special attention should be paid to the long-term preservation of renal function in these patients, particularly those with hypertension and/or episodes of acute pyelonephritis.

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Abbreviations & Acronyms BMI = body mass index CCI = Charlson Comorbidity Index CIS = carcinoma in situ CSS = cancer-specific survival eGFR = estimated glomerular filtration rate HR = hazard ratio IQR = interquartile range KPS = Karnofsky Performance Status LVI = lymphovascular invasion OS = overall survival PS = performance status RC = radical cystectomy RFS = recurrence-free survival Objectives: To assess the significance of performance status as a prognostic factor after radical cystectomy for urothelial carcinoma of the bladder. Methods: The present study included 730 consecutive patients with urothelial carcinoma of the bladder who underwent radical cystectomy. Clinicopathological outcomes in these patients were analyzed focusing on the impact of performance status, which was assessed using the Karnofsky Performance Status scale before surgery. Patients were classified into groups with Karnofsky Performance Status 90 and 80. Results: A total of 561 (76.8%) and 169 (23.2%) patients were judged to have Karnofsky Performance Status 90 and 80, respectively. During a mean of 52.0 months, disease recurrence and mortality occurred in 257 (35.2%) and 249 (34.1%) patients, respectively, and the 5-year recurrence-free and overall survival rates were 64.1 and 65.3%, respectively. There were significant differences in age, hemoglobin, albumin, estimated glomerular filtration rate, pathological T stage and nodal involvement between the Karnofsky Performance Status 90 and 80 groups. Multivariate analysis showed independent impacts of Karnofsky Performance Status, pathological T stage, nodal involvement and lymphovascular invasion on recurrence-free survival, as well as independent impacts of Karnofsky Performance Status, age, body mass index, hemoglobin, pathological T stage, nodal involvement and lymphovascular invasion on overall survival. Conclusions: The results suggest a significant association between impaired performance status and unfavorable prognosis in patients with urothelial carcinoma of the bladder undergoing radical cystectomy.

These findings suggest that the combined assessment of expression levels of autophagy-associated markers, particularly Beclin 1, in radical nephrectomy specimens with conventional prognostic parameters, would contribute to the precise prediction of postoperative disease recurrence in patients with non-metastatic CCRCC.