Norris Comprehensive Cancer Center, University of Southern California Institute of Urology, Los Angeles, CA, USA.
BJU Int. 2014 Jun;113(6):887-93. doi: 10.1111/bju.12240. Epub 2013 Jul 26.
To evaluate the impact of the preoperative American Society of Anesthesiologists (ASA) score and serum albumin level on complications, recurrences and survival rates of patients who underwent radical cystectomy (RC) for urothelial bladder cancer (UBC).
In all, 1964 patients underwent RC for UBC at our institution between 1971 and 2008. Preoperative serum albumin and ASA score were available in 1471 and 1140 patients, respectively. A complication was defined as any surgery related/unrelated event leading to lengthening hospital stay or re-admission. Endpoints were 90-day complication (90dC) rate, recurrence-free survival (RFS) and overall survival (OS).
The median (range) follow-up was 12.4 (0.2-27.3) years. In all, 197 patients (13.4%) had a low albumin level (<3.5 g/dL) and 740 (64.8%) had a high ASA score (3 or 4). Low serum albumin and a high ASA score were associated with higher 90dC rate (42% vs 34%, P = 0.03 and 40% vs 28%, P < 0.001, respectively). On multiple logistic regression analysis, a high ASA score remained independently associated with increased 90dC rate (hazard ratio [HR] 1.52, P = 0.005) and decreased OS (HR 1.45, 95% confidence interval [CI] 1.13-1.86). A low serum albumin level was also independently associated with RFS (HR 1.68, 95% CI 1.16-2.43) and OS (HR 1.93, 95% CI 1.43-2.63).
A low serum albumin level was independently associated with cancer recurrence and decreased OS after RC. A high ASA score was also independently associated with decreased OS. These parameters potentially could be used as prognosticators after RC.
评估术前美国麻醉医师协会（ASA）评分和血清白蛋白水平对接受根治性膀胱切除术（RC）治疗尿路上皮膀胱癌（UBC）患者的并发症、复发率和生存率的影响。
1971 年至 2008 年间，共有 1964 例 UBC 患者在我院接受 RC。分别有 1471 例和 1140 例患者的术前血清白蛋白和 ASA 评分可用。并发症定义为任何导致住院时间延长或再次入院的手术相关/不相关事件。终点为 90 天并发症（90dC）发生率、无复发生存率（RFS）和总生存率（OS）。
中位（范围）随访时间为 12.4（0.2-27.3）年。共有 197 例（13.4%）患者血清白蛋白水平较低（<3.5 g/dL），740 例（64.8%）患者 ASA 评分较高（3 或 4）。低血清白蛋白和高 ASA 评分与更高的 90dC 发生率相关（42%比 34%，P=0.03 和 40%比 28%，P<0.001）。在多因素逻辑回归分析中，高 ASA 评分仍然与 90dC 发生率增加相关（危险比[HR]1.52，P=0.005）和 OS 降低相关（HR 1.45，95%置信区间[CI]1.13-1.86）。低血清白蛋白水平也与 RFS（HR 1.68，95%CI 1.16-2.43）和 OS（HR 1.93，95%CI 1.43-2.63）相关。
低血清白蛋白水平与 RC 后癌症复发和 OS 降低独立相关。高 ASA 评分也与 OS 降低独立相关。这些参数在 RC 后可能可用作预后指标。
