Factors affecting one-year survival after radical cystectomy: A prospective study.

Introduction: Survival after radical cystectomy (RC) is affected by various factors. Significance of preoperative health status and its influence on treatment outcome is uncertain. The aim of the study was to prospectively evaluate overall survival, cause of death and the role of comorbidities in mortality during the first 12 months following RC.

Material and methods: All patients who underwent RC between January 2014 and May 2016 for T1-T4 bladder cancer in a single center were prospectively followed. Stage and comorbidities were explored as predictors of overall survival (OS). Patient status was assessed for at least 12 months.

Results: Follow-up was available for 25 men and 19 women at the mean age 67. Median time of follow-up for survivors was 16 months. Six-month and 1-year OS was 84% and 77%. Out of 11 deaths, 8 were related to cancer progression and 3 patients died for other causes. All deaths apart from one occurred in the first year after surgery. One-year OS was affected mostly by tumor stage: 95% for pT1-2 vs. 62.5% for pT3-4; p = 0.01. Worse outcome was found in patients ≥72 years old, (44% vs. 86%; p = 0.02) and among women (63% vs. 88%; p = 0.07). When patients who died were compared to survivors the following distribution of comorbidities was found: diabetes mellitus - 30.0% vs. 11.8%, p = 0.3; history of stroke - 30.0% vs. 2.9%, p = 0.1; thyroid disease - 30.0% vs. 11.8%, p = 0.3.

Conclusions: Majority of patients died because cystectomy was performed too late. History of stroke, diabetes mellitus, and thyroid diseases should be assessed as possible risk factors in larger studies.