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MP61-13 CAN THE RACIAL DISPARITY IN MORTALITY FOLLOWING CYSTECTOMY FOR UCC BE EXPLAINED?
THE JOURNAL OF UROLOGYâ
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regression models assessed the impact of preoperative characteristics on UD and diversion-related complication rates. RESULTS: The median age was 71 years (IQR 63-77) and 79.9% patients were male. In total, 27.6% of patients received an orthotopic neobladder, 2.9% continent cutaneous pouches, 60.3% ileal conduits, and 9.2% a ureterocutaneostomy, respectively. A significant number of patients had considerable comorbidities (American Society of Anesthesiology (ASA) score 3: 48.6%; Age adjusted CharlsonComorbidity Index (ACCI) >3: 67.1%; status post myocardial infarction: 10.6%; status post cerebral insult: 6.8%). In addition, 26.6% were active smokers at time of RC and 32.7% of patients had elevated serum creatinine, with 5.7% presenting with chronic kidney disease stage 4 or 5. On multivariable analysis that adjusted for all pre-RC parameters, female gender (OR: 0.368; p¼0.017), ASA score 3 (OR: 0.466; p¼0.030) and an ACCI >3 (OR: 0.292; p<0.001) were independently associated with incontinent UD. Overall, 60.7% of patients experienced any complication within 365 days, with 27.1% experiencing a major complication (Clavien 3). Patients with incontinent UD were at significantly increased risk experiencing a complication within 60-days after RC (OR: 1.861, p¼0.047) on multivariable analysis. Overall complications or any major complications did not significantly differ between continent vs. incontinent UD. CONCLUSIONS: In this very contemporary, prospective series, the majority of patients received incontinent UD, although continent UD after RC is considered the treatment of choice today. Female gender and increased preoperative comorbidities significantly influence decision-making regarding UD. Despite significant preoperative comorbidities, RC is feasible with a moderate risk of major complications independent of the UD type. Source of Funding: none
MP61-13 CAN THE RACIAL DISPARITY IN MORTALITY FOLLOWING CYSTECTOMY FOR UCC BE EXPLAINED? Deborah R. Kaye*, Joseph K. Canner, Eric B. Schneider, Adil H. Haider, Mark P. Schoenberg, Trinity J. Bivalacqua, Baltimore, MD INTRODUCTION AND OBJECTIVES: Racial disparities in bladder cancer survival after radical cystectomy for urothelial cell carcinoma (UCC) have been documented, with no known etiology. Most analyses do not adequately control for patient and tumor characteristics. We aimed to evaluate factors affecting differences in survival between black and white patients in a matched cohort analysis. METHODS: Using Surveillance, Epidemiology, and End Results Program (SEER) data from 1983-2010, black patients with TCC of the bladder treated with radical cystectomy were case-matched to whites on demographics (sex, age), year of diagnosis, stage at cystectomy, region, and number of primary cancers. Primary outcomes were all-cause and cancer-specific mortality. Cox regression analyses were performed for the unmatched and matched cohorts. RESULTS: 21,232 white and 1,410 black patients were included in the unmatched analysis. Blacks had worse all-cause and cancer-specific mortality than whites when unmatched. The matched cohort consisted of 1346 blacks matched roughly 1:10 to whites. In the univariate matched analysis, race was a significant predictor of allcause and cancer-specific mortality (HR 0.82, P < 0.001; HR 0.88, p ¼ 0.006, respectively), but only predicted all cause mortality in the matched multivariable regression (HR 0.8, p ¼ 0.002). Cancer-specific mortality was equal for blacks and whites in the matched multivariable analysis (HR 0.96, p ¼ 0.42). Predictors of cancer-specific mortality in the matched analysis were age, female sex, year of diagnosis, stage of disease, region, and number of primary malignancies. In the overall cohort, blacks were more likely to be female (40.3% vs 25.4%, p<0.001), have a cystectomy at advanced stages (stage IV) (40.5% vs 32.5%, p<0.001) and were less likely to be married (42.6% vs 66.2%, p<0.001). Additional analyses suggest that the primary determinants for removing the cancer-specific survival race disparity were marital status and stage at cystectomy.
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
CONCLUSIONS: Black patients who undergo a cystectomy are more likely to die with and because of bladder cancer. However, when matched to whites, blacks still have worse overall mortality, but not cancer-specific mortality. Stage at diagnosis and marital status were the prime determinants for the change in significance. Differences in cancer-specific mortality are secondary to the matched characteristics with particular emphasis on cancer stage at cystectomy, co-morbidities, and marital status. Source of Funding: None
MP61-14 RADICAL CYSTECTOMY (RC) IN OCTOGENARIANS : LONG-TERM EXPERIENCE OF TWO HIGH VOLUME INSTITUTIONS Maurizio Brausi*, Carpi, Italy; Cesare Selli, Azzurra Guerra, Pisa, Italy; massimo viola, carpi, Italy; Giancarlo Peracchia, Giuseppe De Luca, Carpi, Italy INTRODUCTION AND OBJECTIVES: The objectives of the study were to evaluate morbidity, overall survival (OS) and disease specific survival (DSS) of radical cystectomy (RC) in octogenarians in two urological centers METHODS: From 2000 to 2012, 1010 pts with infiltrative or recurrent high grade T1 TCC of the bladder received RC and urinary diversion in 2 italian institutions. 170/1010 patients (16.8%) were 80 years old or older. The mean age was 83.2 years: M/F: 128/42. ASA score was used for classifying preop. risk. ASA 2: 56/170 (33%),ASA 3: 75/170 (44.1%), ASA 4 : 39/170 (23%).113/170 pts.(66.5%) received uretero-cutaneostomy (UCS) as a diversion while 42/170 (25%) had Bricker, 14/170 pts (8.3%) had an orthotopic neobladder, 1/170 pt. had an ureterosigmoidostomy(0.5%).P stage was: T0 : 1 Pt (0.5%). Tis+TaT1: 25/170 pts (14.7%); T2b:35/170 (20.6%);T3a: 32/170 (19%); T3b: 45/170 (26.5%); T4: 32/170 (19%).Grade. G3:153/170 pts (90%), G2:17/170 (10%).33 pts. did not received pelvic lymph adenectomy (salvage RC). 29/137 pts (21%) were N+(pT3-T4). 125/170 pts (73.5%) were in intensive care Unit (ICU) for 1-6 days. 81/170 pts (47.6%) were transfused. The average blood unit received was 3.5 U. RESULTS: The mean follow-up was 44.5 months (21-118 months).Peri operative mortality was 7.6% (13/170).Mean hospital stay was 14.5 days (7-35 days). The complication rate (medical and surgical) was 43%.8.3% of patients required a second operation.Medical and surgical complications by ASA were: ASA2 ¼11.8%, ASA 3¼ (50%), ASA4 ¼ 38% respectively.The medical complication rate by surgical approach: extraperitoneal ¼ 40.4%, peritoneal ¼ 27%;surgical complication rate : extraperitoneal route ¼12.8%,trans-peritoneal approach ¼ 30% (p < 0.001). Complication rate by diversion: UCS ¼ 26% Bricker ¼ 49.2%, Orthotopic ¼ 45% (p<0.001). OS: After 1 year ¼ 60%, 2 years ¼ 43.6%, 3 year ¼ 40% . DSS was 63.3% at 1 year, 51.2% at 2 years and 50% after 3 years. . CONCLUSIONS: The results of our study support the use of RC in octogenarians. Mortality and complications were acceptable. Mayor complications were correlated with high ASA score (3-4), type of urinary diversion (Bricker) and surgical approach ( intraperitoneal). Source of Funding: Radical Cistectomy in elderly patients
MP61-15 IMPACT OF GENDER ON POST-CYSTECTOMY BLADDER CANCER OUTCOMES: DIFFERENCES IN OBSERVATIONS BETWEEN MATCHED AND UNMATCHED CASE-CONTROL APPROACHES Anirban P. Mitra*, Los Angeles, CA; Eila C. Skinner, Stanford, CA; Anne K. Schuckman, David I. Quinn, Tanya B. Dorff, Siamak Daneshmand, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Prior studies have reported that females experience worse outcomes following radical cystectomy for urothelial carcinoma of the bladder (UCB). However, the
e688
regression models assessed the impact of preoperative characteristics on UD and diversion-related complication rates. RESULTS: The median age was 71 years (IQR 63-77) and 79.9% patients were male. In total, 27.6% of patients received an orthotopic neobladder, 2.9% continent cutaneous pouches, 60.3% ileal conduits, and 9.2% a ureterocutaneostomy, respectively. A significant number of patients had considerable comorbidities (American Society of Anesthesiology (ASA) score 3: 48.6%; Age adjusted CharlsonComorbidity Index (ACCI) >3: 67.1%; status post myocardial infarction: 10.6%; status post cerebral insult: 6.8%). In addition, 26.6% were active smokers at time of RC and 32.7% of patients had elevated serum creatinine, with 5.7% presenting with chronic kidney disease stage 4 or 5. On multivariable analysis that adjusted for all pre-RC parameters, female gender (OR: 0.368; p¼0.017), ASA score 3 (OR: 0.466; p¼0.030) and an ACCI >3 (OR: 0.292; p<0.001) were independently associated with incontinent UD. Overall, 60.7% of patients experienced any complication within 365 days, with 27.1% experiencing a major complication (Clavien 3). Patients with incontinent UD were at significantly increased risk experiencing a complication within 60-days after RC (OR: 1.861, p¼0.047) on multivariable analysis. Overall complications or any major complications did not significantly differ between continent vs. incontinent UD. CONCLUSIONS: In this very contemporary, prospective series, the majority of patients received incontinent UD, although continent UD after RC is considered the treatment of choice today. Female gender and increased preoperative comorbidities significantly influence decision-making regarding UD. Despite significant preoperative comorbidities, RC is feasible with a moderate risk of major complications independent of the UD type. Source of Funding: none
MP61-13 CAN THE RACIAL DISPARITY IN MORTALITY FOLLOWING CYSTECTOMY FOR UCC BE EXPLAINED? Deborah R. Kaye*, Joseph K. Canner, Eric B. Schneider, Adil H. Haider, Mark P. Schoenberg, Trinity J. Bivalacqua, Baltimore, MD INTRODUCTION AND OBJECTIVES: Racial disparities in bladder cancer survival after radical cystectomy for urothelial cell carcinoma (UCC) have been documented, with no known etiology. Most analyses do not adequately control for patient and tumor characteristics. We aimed to evaluate factors affecting differences in survival between black and white patients in a matched cohort analysis. METHODS: Using Surveillance, Epidemiology, and End Results Program (SEER) data from 1983-2010, black patients with TCC of the bladder treated with radical cystectomy were case-matched to whites on demographics (sex, age), year of diagnosis, stage at cystectomy, region, and number of primary cancers. Primary outcomes were all-cause and cancer-specific mortality. Cox regression analyses were performed for the unmatched and matched cohorts. RESULTS: 21,232 white and 1,410 black patients were included in the unmatched analysis. Blacks had worse all-cause and cancer-specific mortality than whites when unmatched. The matched cohort consisted of 1346 blacks matched roughly 1:10 to whites. In the univariate matched analysis, race was a significant predictor of allcause and cancer-specific mortality (HR 0.82, P < 0.001; HR 0.88, p ¼ 0.006, respectively), but only predicted all cause mortality in the matched multivariable regression (HR 0.8, p ¼ 0.002). Cancer-specific mortality was equal for blacks and whites in the matched multivariable analysis (HR 0.96, p ¼ 0.42). Predictors of cancer-specific mortality in the matched analysis were age, female sex, year of diagnosis, stage of disease, region, and number of primary malignancies. In the overall cohort, blacks were more likely to be female (40.3% vs 25.4%, p<0.001), have a cystectomy at advanced stages (stage IV) (40.5% vs 32.5%, p<0.001) and were less likely to be married (42.6% vs 66.2%, p<0.001). Additional analyses suggest that the primary determinants for removing the cancer-specific survival race disparity were marital status and stage at cystectomy.
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
CONCLUSIONS: Black patients who undergo a cystectomy are more likely to die with and because of bladder cancer. However, when matched to whites, blacks still have worse overall mortality, but not cancer-specific mortality. Stage at diagnosis and marital status were the prime determinants for the change in significance. Differences in cancer-specific mortality are secondary to the matched characteristics with particular emphasis on cancer stage at cystectomy, co-morbidities, and marital status. Source of Funding: None
MP61-14 RADICAL CYSTECTOMY (RC) IN OCTOGENARIANS : LONG-TERM EXPERIENCE OF TWO HIGH VOLUME INSTITUTIONS Maurizio Brausi*, Carpi, Italy; Cesare Selli, Azzurra Guerra, Pisa, Italy; massimo viola, carpi, Italy; Giancarlo Peracchia, Giuseppe De Luca, Carpi, Italy INTRODUCTION AND OBJECTIVES: The objectives of the study were to evaluate morbidity, overall survival (OS) and disease specific survival (DSS) of radical cystectomy (RC) in octogenarians in two urological centers METHODS: From 2000 to 2012, 1010 pts with infiltrative or recurrent high grade T1 TCC of the bladder received RC and urinary diversion in 2 italian institutions. 170/1010 patients (16.8%) were 80 years old or older. The mean age was 83.2 years: M/F: 128/42. ASA score was used for classifying preop. risk. ASA 2: 56/170 (33%),ASA 3: 75/170 (44.1%), ASA 4 : 39/170 (23%).113/170 pts.(66.5%) received uretero-cutaneostomy (UCS) as a diversion while 42/170 (25%) had Bricker, 14/170 pts (8.3%) had an orthotopic neobladder, 1/170 pt. had an ureterosigmoidostomy(0.5%).P stage was: T0 : 1 Pt (0.5%). Tis+TaT1: 25/170 pts (14.7%); T2b:35/170 (20.6%);T3a: 32/170 (19%); T3b: 45/170 (26.5%); T4: 32/170 (19%).Grade. G3:153/170 pts (90%), G2:17/170 (10%).33 pts. did not received pelvic lymph adenectomy (salvage RC). 29/137 pts (21%) were N+(pT3-T4). 125/170 pts (73.5%) were in intensive care Unit (ICU) for 1-6 days. 81/170 pts (47.6%) were transfused. The average blood unit received was 3.5 U. RESULTS: The mean follow-up was 44.5 months (21-118 months).Peri operative mortality was 7.6% (13/170).Mean hospital stay was 14.5 days (7-35 days). The complication rate (medical and surgical) was 43%.8.3% of patients required a second operation.Medical and surgical complications by ASA were: ASA2 ¼11.8%, ASA 3¼ (50%), ASA4 ¼ 38% respectively.The medical complication rate by surgical approach: extraperitoneal ¼ 40.4%, peritoneal ¼ 27%;surgical complication rate : extraperitoneal route ¼12.8%,trans-peritoneal approach ¼ 30% (p < 0.001). Complication rate by diversion: UCS ¼ 26% Bricker ¼ 49.2%, Orthotopic ¼ 45% (p<0.001). OS: After 1 year ¼ 60%, 2 years ¼ 43.6%, 3 year ¼ 40% . DSS was 63.3% at 1 year, 51.2% at 2 years and 50% after 3 years. . CONCLUSIONS: The results of our study support the use of RC in octogenarians. Mortality and complications were acceptable. Mayor complications were correlated with high ASA score (3-4), type of urinary diversion (Bricker) and surgical approach ( intraperitoneal). Source of Funding: Radical Cistectomy in elderly patients
MP61-15 IMPACT OF GENDER ON POST-CYSTECTOMY BLADDER CANCER OUTCOMES: DIFFERENCES IN OBSERVATIONS BETWEEN MATCHED AND UNMATCHED CASE-CONTROL APPROACHES Anirban P. Mitra*, Los Angeles, CA; Eila C. Skinner, Stanford, CA; Anne K. Schuckman, David I. Quinn, Tanya B. Dorff, Siamak Daneshmand, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Prior studies have reported that females experience worse outcomes following radical cystectomy for urothelial carcinoma of the bladder (UCB). However, the