INTRODUCTION AND OBJECTIVE: Despite several improvements in surgical technique, radical cystectomy (RC) remains an highly morbid operation and even in contemporary series the combined surgical, medical and disease morbidity results in a low 5-years overall survival (OS). Furthermore, the age of patients undergoing RC has increased and the ability to predict perioperative morbidity is crucial in the preoperative workup of RC. The controlling nutritional status (CONUT), a score based on the serum albumin concentration, lymphocyte count and total cholesterol concentration, is a comprehensive index that could provide an immune response status and long-term nutritional effect of the host. Recently, its prognostic value has been reported in many types of malignancies but it’s never tested in bladder cancer (BC). The aim of the study is to evaluate the role of preoperative CONUT score in the assessment of both oncological outcomes and perioperative morbidity in patients underwent RC for non-metastatic BC. METHODS: We retrospectively evaluated data from 347 patients who underwent RC for BC at ve european high-volume centers between January 2002 and December 2018. Patients were divided into two groups according to the optimal cut-off value of CONUT score. Relationships of CONUT score with clinicopathological characteristics, perioperative complications (according to the Calvien-Dindo system), 30-days readmission, 90-days mortality, cancer-specific mortality (CSM), overall mortality (OM) and progression-free survival (PFS) were analyzed. RESULTS: Cut-off value to discriminate between high and low CONUT score was determined calculating the ROC curve: the area under the curve was 0.72 with an optimal cut-off of 3 points. High preoperative CONUT score was significantly correlated with older age, worse ASA score, advanced pT stage, high grade and node-positive disease, higher median length of stay and 30-days readmission (all p<0.05). At multivariable binomial logistic regression analysis adjusted for age, sex, BMI, ASA score, pT, pN and type of urinary diversion, high CONUT was an independent predictor of perioperative major complications (grade 3-5) (OR 2.9; 95%CI 1.6-5.4; p<0.001) and 30-days readmission(2.5; 95%CI 1.3-4.9; p=0.001). At multivariable Cox's regression analysis adjusted for age, sex, BMI, ASA score, presence of adjuvant therapy, pT, pN, LVI, positive surgical margins and concomitant cis, high CONUT was an independent predictor of CSM(HR 3.6; 95%CI 2.4-5.5; p<0.001), OM(HR 2.5; 95%CI 1.7-3.4; p<0.001) and worse PFS(HR 2.7; 95%CI 1.9-3.9; p<0.001). CONCLUSIONS: Preoperative CONUT score can be used as a simple and inexpensive biomarker to predict perioperative morbidity and survival outcomes in patients with BC after radical cystectomy.
PD60-10 IMPACT OF PREOPERATIVE CONTROLLING NUTRITIONAL STATUS (CONUT) SCORE ON PERIOPERATIVE MORBIDITY AND SURVIVAL OUTCOMES IN PATIENTS WITH BLADDER CANCER TREATED WITH RADICAL CYSTECTOMY: A MULTICENTER ANALYSIS
Francesco Claps;Carlo Trombetta
2020-01-01
Abstract
INTRODUCTION AND OBJECTIVE: Despite several improvements in surgical technique, radical cystectomy (RC) remains an highly morbid operation and even in contemporary series the combined surgical, medical and disease morbidity results in a low 5-years overall survival (OS). Furthermore, the age of patients undergoing RC has increased and the ability to predict perioperative morbidity is crucial in the preoperative workup of RC. The controlling nutritional status (CONUT), a score based on the serum albumin concentration, lymphocyte count and total cholesterol concentration, is a comprehensive index that could provide an immune response status and long-term nutritional effect of the host. Recently, its prognostic value has been reported in many types of malignancies but it’s never tested in bladder cancer (BC). The aim of the study is to evaluate the role of preoperative CONUT score in the assessment of both oncological outcomes and perioperative morbidity in patients underwent RC for non-metastatic BC. METHODS: We retrospectively evaluated data from 347 patients who underwent RC for BC at ve european high-volume centers between January 2002 and December 2018. Patients were divided into two groups according to the optimal cut-off value of CONUT score. Relationships of CONUT score with clinicopathological characteristics, perioperative complications (according to the Calvien-Dindo system), 30-days readmission, 90-days mortality, cancer-specific mortality (CSM), overall mortality (OM) and progression-free survival (PFS) were analyzed. RESULTS: Cut-off value to discriminate between high and low CONUT score was determined calculating the ROC curve: the area under the curve was 0.72 with an optimal cut-off of 3 points. High preoperative CONUT score was significantly correlated with older age, worse ASA score, advanced pT stage, high grade and node-positive disease, higher median length of stay and 30-days readmission (all p<0.05). At multivariable binomial logistic regression analysis adjusted for age, sex, BMI, ASA score, pT, pN and type of urinary diversion, high CONUT was an independent predictor of perioperative major complications (grade 3-5) (OR 2.9; 95%CI 1.6-5.4; p<0.001) and 30-days readmission(2.5; 95%CI 1.3-4.9; p=0.001). At multivariable Cox's regression analysis adjusted for age, sex, BMI, ASA score, presence of adjuvant therapy, pT, pN, LVI, positive surgical margins and concomitant cis, high CONUT was an independent predictor of CSM(HR 3.6; 95%CI 2.4-5.5; p<0.001), OM(HR 2.5; 95%CI 1.7-3.4; p<0.001) and worse PFS(HR 2.7; 95%CI 1.9-3.9; p<0.001). CONCLUSIONS: Preoperative CONUT score can be used as a simple and inexpensive biomarker to predict perioperative morbidity and survival outcomes in patients with BC after radical cystectomy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
