Preoperative predictors of early death risk in bladder cancer patients treated with robot-assisted radical cystectomy

Abstract

Background: Early identification of early death for bladder cancer patients undergoing radical cystectomy based on the laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for bladder cancer patients. Methods: A total of 186 bladder cancer patients who underwent robot-assisted radical cystectomy (RARC) were identified between October 2014 and May 2017. The probability of dying within 1 year after RARC was defined as the end point “early death.” Predictive factors including clinical features and laboratory findings at diagnosis were retrospectively collected. Results: Median follow-up time after RARC was 20.6 months (1.2-43.7 months). Fifty-one patients (27.4%) died during follow-up and 31 within 1 year from surgery (1-year mortality rate: 16.7%). All potentially prognostic factors were assessed on univariate analyses, which revealed the following factors as being associated with higher risk of early death within 1 year after RARC: older age (P = 0.004), advanced clinical stage (P = 0.005), presence of hydronephrosis (P = 0.021), higher fibrinogen (P = 0.007), higher PLR (P = 0.031), and lower PNI (P = 0.016). In a multivariate Cox proportional hazard regression model analysis, age >60 years (HR = 7.303, 95% CI 1.734-30.764; P = 0.007) and fibrinogen ≥3.295 g/L (HR = 2.396, 95% CI 1.138-5.045; P = 0.007) at diagnosis were independent prognostic factors of early death after RARC. Conclusion: Age and preoperative elevated plasma fibrinogen level were independent predictors for 1-year mortality after RARC. We believe that plasma fibrinogen levels may become a useful biomarker, which may help guide the treatment decision-making process for patients with bladder cancer.