Post-Cystectomy Deaths Among HD Patients Seldom Due to Cancer

Following radical cystectomy for bladder cancer, end-stage renal disease patients are 3-4 times more likely to die from causes other than cancer.
Following radical cystectomy for bladder cancer, end-stage renal disease patients are 3-4 times more likely to die from causes other than cancer.
The following article is part of conference coverage from the 2017 American Urological Association meeting in Boston. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2017. 

BOSTON—Hemodialysis (HD) patients who undergo radical cystectomy (RC) for bladder cancer are much more likely to die from causes other than cancer, study findings presented at the American Urological Association 2017 annual meeting in Boston suggest.

In addition, the study found that smoking was the only independent predictor of death from cancer, researchers at the University of Chicago Medical Center led by Scott Johnson, MD, reported.

As Dr Johnson explained, patients with end-stage renal disease (ESRD) are at increased risk for bladder cancer and are more likely to present with an advanced stage of the disease. “We know that ESRD patients have a significant overall risk of mortality, making decision to perform high-risk surgery such as radical cystectomy very difficult,” Dr Johnson told Renal & Urology News. “Unfortunately, there is very little known about the outcomes of these patients, which was the impetus for our study. Importantly, we found that following cystectomy, ESRD patients are 3 to 4 times more likely to die of causes other than cancer. We identified several independent predictors of cancer-specific and overall mortality which we hope will help guide treatment decisions in this vulnerable population.”

The study included 985 HD patients (mean age 68.3 years, 72% male) who underwent RC for bladder cancer from 1984 to 2013. Patients were on dialysis for an average of 3.2 years prior to cystectomy. The 30-day mortality rate was 9.3%. The 1-, 3- and 5-year cancer-specific mortality rates were 12.3%, 18.4%, and 19.7%, respectively. The overall mortality rates were 51.7%, 77.3%, and 87.9%, respectively.

The study also found that each 1-year increase in patient age was associated with 2% increased risk of all-cause mortality. The presence of diabetes, compared with its absence, was associated with a 33% increased risk. Urinary diversion was found to be protective, with 17% decreased risk of all-cause mortality. Smoking was associated with a 70% increased risk of cancer-specific death versus not smoking. All of these associations were statistically significant.

“Although we have found a sobering risk of perioperative and overall mortality in this population, we hope that some of this data can be used to better counsel patients and identify those most appropriate to undergo cystectomy,” Dr Johnson said.

He noted that an important limitation of the study was the absence of stage information, which if known could impact cancer-specific survival significantly.

Visit Renal and Urology News' conference section for continuous coverage from AUA 2017.

Reference

Johnson S, Smith Z, Rodriguez J III, Steinberg G. Perioperative and long term outcomes after radical cystectomy in hemodialysis patients. [abstract]. J Urol 2017;197(4S):e34. Poster presented at the American Urological Association 2017 annual meeting in Boston on May 12, 2017. MP04-16.
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