Andrea Mari, Fabrizio Di Maida, Riccardo Campi, Riccardo Bossa, Emanuele Avola, Giulia Bencini, Graziano Vignolini, Alberto Lapini, Sergio Serni, Marco Carini, Andrea Minervini.
Clinica Urologica I, AOUC, Università di Firenze, Italia.
Introduction: To evaluate the impact of hypoalbuminemia on survival rates of patients who had >=80 years and underwent radical cystectomy (RC) for urothelial bladder cancer (UBC).
Methods: Overall, the clinical data of 450 patients submitted to RC for UBC at our institution between January 2007 and December 2015 were retrospectively recorded. Of these, 109 elderly patients (age >= 80 years) were selected. Preoperative hypoalbuminemia was defined as serum albumin < 3.5 g/dL. Overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method and the different groups were compared using the log-rank test. A pre- and postoperative multivariable Cox proportional hazard regression models were fitted.
Results: Patients had a median preoperative serum albumin of 4.0 (IQR 3.8-4.3) g/dL and hypoalbuminemia was registered in 16 (14.7%). Median age was 84 (IQR 81-86, range: 80-92) years. Charlson comorbidity index (CCI) was 3 (IQR 2-4). Clinical T3-4 and N+ were recorded in 11 (10.1%) and 9 (8.3%) of patients. Preoperative hydronephrosis was registered in .0 (28.4%) of patients. pT3-4 and pN1-2 were recorded in 69 (63.4%) and in 16 (14.7%) of patients. Median follow-up was 24.6 (IQR 14.5-35.1) months. The actuarial 3-yrs and 5-yrs OS was 40.9% (SE 5.4%) and 16.8% (SE 5.5%). The actuarial 3-yrs and 5-yrs CSS was 62.2% (SE 5.7%) and 45.7% (SE 10.2%). Patients with preoperative hypoalbuminemia were significantly associated with a lower OS (p=0.01) and a lower CSS (p<0.0001) (Figure 1). Preoperative hypoalbuminemia was independently associated with OS at both preoperative (HR: 2.22, CI95% 1.16-4.23, p=0.01) and postoperative (HR:2.06, CI95% 1.13-3.78, p=0.02) models of multivariable regression analysis after adjusting for established clinicopathological features.
Conclusion: Elderly patients with preoperative hypoalbuminemia seem to have a worst oncologic outcome after RC. The evaluation of serum preoperative albumin could be useful for improving clinical outcome predictions for elderly patients undergoing RC.