Introduction

A recent study within a highly-select patient cohort suggested a survival benefit when local treatment is delivered in patients with metastatic bladder cancer (BCa). We relied on a similar patient cohort to examine in-hospital mortality (IHM) rates according to presence, absence and location of metastatic disease in BCa patients treated with radical cystectomy (RC).

Methods

We identified 25,004 BCa patients treated with RC between 2004 and 2013 from the hospital claims data in the National Inpatients Sample database. Using International Classification of Diseases, 9th edition (ICD-9-CM) diagnostic codes, we identified 5,049 patients with metastatic disease. Metastatic BCa patients were stratified according to the presence of non-regional lymph node metastases (NRNM) in absence of distant organ involvement vs. presence of distant organ metastases (DM), regardless of nodal status._x000D_ We tested postoperative IHM rates according to presence of metastases, as well as location of metastatic disease (NRNM vs. DM). Logistic regression analyses were adjusted for age, gender, race, comorbidities, length of hospitalization, hospital location, teaching status, hospital surgical volume and bed size.

Results

Overall, 3,323 patients (13.3%) had NRNM, 1,726 (6.9%) had DM, and 19,965 (79.8%) had non-metastatic disease. Virtually all metastatic patients had a single metastatic site involvement (n=4,458; 88.5%), while only a small proportion of individuals had metastatic involvement in 3 or more sites (n=57; 1.1%). The most common metastatic sites were lymph nodes (76.0%; n=3,830), other urinary organs (23.2%; n=1,168), intestine (4.7%; n=235) and retroperitoneum (4.1%; n=209). Interestingly, bone and liver metastases represented only 1.6% (n=81) and 1.1% (n=55) of cases, respectively._x000D_ IHM rates were 1.5% (n=51), 3.5% (n=60) and 2.0% (n=404) for NRNM, DM and non-metastatic patients, respectively. The difference in IHM rates between DM and non-metastatic BCa patients was statistically significant (p<0.001). Conversely, NRNM patients did not exhibit different mortality rates than their counterparts without metastatic disease (p=0.07). In multivariable logistic regression analyses, DM patients (OR: 1.68; 95% CI: 1.26-2.20; p<0.001), but not NRNM patients (OR: 0.84; 95% CI: 0.62-1.11; p=0.2), were at increased risk of IHM.

Conclusions

DM patients are at an increased risk of IHM, compared to NRNM or non-metastatic patients. If at all indicated, RC in metastatic setting should be limited to patients with NRNM.

Funding

none