Decreasing Non-bladder-cancer Mortality After Radical Cystectomy.

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Increasing global life expectancy presents challenges for managing age-related diseases.
• Radical cystectomy is a critical treatment for bladder cancer.
• Evolving patient demographics and treatment protocols necessitate re-evaluation of surgical outcomes.

Purpose of the Study:

• To investigate the impact of increasing life expectancy and surgical year on outcomes after radical cystectomy for bladder cancer.
• To analyze trends in competing mortality and their relationship with surgical timing.

Main Methods:

• Utilized proportional hazard models for competing risks analysis.
• Examined data from 1419 consecutive radical cystectomy patients treated between 1993 and 2018.
• Developed an optimal model incorporating age, comorbidity, tumor characteristics, BMI, chemotherapy, and smoking status.

Main Results:

• Competing mortality (non-bladder cancer deaths) decreased significantly over the study period (HR per year 0.931-0.963).
• After adjusting for multiple factors, the year of surgery remained a significant predictor of improved outcomes (HR 0.928, p=0.0019).
• The positive effect of surgical year on outcomes exceeded the expected decrease in competing mortality due to increased life expectancy.

Conclusions:

• Outcomes after radical cystectomy have demonstrably improved over time, independent of competing mortality trends.
• The year of surgery is a significant factor influencing patient survival post-cystectomy.
• These findings suggest that advancements in surgical care may allow older bladder cancer patients to benefit from radical cystectomy.