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Scheipner L, Zurl H, Altziebler JV, Pichler GP, Schöpfer-Schwab S, Jasarevic S, Gaisl M, Pohl KC, Pemberger K, Andlar S, Hutterer GC, Bele U, Leitsmann C, Leitsmann M, Augustin H, Zigeuner R, Ahyai S, Mischinger J. Charlson-Deyo Comorbidity Index as a Novel Predictor for Recurrence in Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2023; 15:5770. [PMID: 38136315 PMCID: PMC10742244 DOI: 10.3390/cancers15245770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/19/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To test the association between the Charlson-Deyo Comorbidity Index (CCI) and the recurrence of non-muscle-invasive bladder cancer (NMIBC). METHODS NMIBC (Ta, T1, TIS) patients who underwent transurethral resection of bladder tumor (TURB) between 2010 and 2018 were identified within a retrospective data repository of a large university hospital. Kaplan-Meier estimates and uni- and multivariable Cox regression models tested for differences in risk of recurrence according to low vs. high comorbidity burden (CCI ≤ 4 vs. >4) and continuously coded CCI. RESULTS A total of 1072 NMIBC patients were identified. The median follow-up time of the study population was 55 months (IQR 29.6-79.0). Of all 1072 NMIBC patients, 423 (39%) harbored a low comorbidity burden vs. 649 (61%) with a high comorbidity burden. Overall, the rate of recurrence was 10% at the 12-month follow-up vs. 22% at the 72-month follow-up. In low vs. high comorbidity burden groups, rates of recurrence were 6 vs. 12% at 12 months and 18 vs. 25% at 72 months of follow-up (p = 0.02). After multivariable adjustment, a high comorbidity burden (CCI > 4) independently predicted a higher risk of recurrence (HR 1.42, 95% confidence interval (CI) 1.06-1.92, p = 0.018). After multivariable adjustment, the hazard of recurrence increased by 5% per each one-unit increase on the CCI scale (HR 1.05, 95% CI 1.00-1.10, p = 0.04). CONCLUSIONS Comorbidities in NMIBC patients are common. Our data suggest that patients with higher CCI have an increased risk of BC recurrence. As a consequence, patients with a high comorbidity burden should be particularly encouraged to adhere to NMIBC guidelines and conform to follow-up protocols.
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Affiliation(s)
- Lukas Scheipner
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Hanna Zurl
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Julia V. Altziebler
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Georg P. Pichler
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Stephanie Schöpfer-Schwab
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Samra Jasarevic
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Michael Gaisl
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Klara C. Pohl
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Karl Pemberger
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Stefan Andlar
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Georg C. Hutterer
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Uros Bele
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Conrad Leitsmann
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Marianne Leitsmann
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
- Institute for Applied Quality Improvement and Research in Health Care, 37073 Goettingen, Germany
| | - Herbert Augustin
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Johannes Mischinger
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
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