Preoperative predictors of early death risk in bladder cancer patients treated with robot‐assisted radical cystectomy

Abstract

Background Early identification of early death for bladder cancer patients undergoing radical cystectomy based on the laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for bladder cancer patients. Methods A total of 186 bladder cancer patients who underwent robot‐assisted radical cystectomy (RARC) were identified between October 2014 and May 2017. The probability of dying within 1 year after RARC was defined as the end point “early death.” Predictive factors including clinical features and laboratory findings at diagnosis were retrospectively collected. Results Median follow‐up time after RARC was 20.6 months (1.2‐43.7 months). Fifty‐one patients (27.4%) died during follow‐up and 31 within 1 year from surgery (1‐year mortality rate: 16.7%). All potentially prognostic factors were assessed on univariate analyses, which revealed the following factors as being associated with higher risk of early death within 1 year after RARC: older age ( P = 0.004), advanced clinical stage ( P = 0.005), presence of hydronephrosis ( P = 0.021), higher fibrinogen ( P = 0.007), higher PLR ( P = 0.031), and lower PNI ( P = 0.016). In a multivariate Cox proportional hazard regression model analysis, age >60 years (HR = 7.303, 95% CI 1.734‐30.764; P = 0.007) and fibrinogen ≥3.295 g/L (HR = 2.396, 95% CI 1.138‐5.045; P = 0.007) at diagnosis were independent prognostic factors of early death after RARC. Conclusion Age and preoperative elevated plasma fibrinogen level were independent predictors for 1‐year mortality after RARC. We believe that plasma fibrinogen levels may become a useful biomarker, which may help guide the treatment decision‐making process for patients with bladder cancer.

Oncological impact of inflammatory biomarkers in elderly patients treated with radical cystectomy for urothelial bladder cancer

“…Nevertheless, data regarding the impact of these biomarkers has never been applied to a selected population of elderly patients. Moreover, the role of preoperative plasma fibrinogen has not been fully investigated in predicting the oncological outcome in patients with UBC [9].…”

Prognostic significance of platelet-to-lymphocyte ratio in urothelial carcinoma patients: a meta-analysis

“…Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are non-invasive and cost-effective prognostic indicators for solid tumors [16–19]. Recent retrospective studies have reported inconsistent findings regarding the prognostic impact of PLR in UC [11, 12, 20–32]. For example, some studies reported a positive association between a high PLR and poor survival in UC [24, 29], whereas others did not [20] or even showed the opposite trend [12, 30].…”

<p>Plasma Fibrinogen Predicts the Prognosis of Bladder Cancer Patients After Radical Cystectomy</p>

“…24 And studies have shown that plasma fibrinogen greater than 3.295g/L was an independent prognostic factor for early death in patients with robot-assisted RC. 25 Our study found that plasma fibrinogen can be used as an independent risk factor for OS and CSS in BCa patients treated with RC. We also found an interesting finding.…”