The association of preoperative serum albumin level and A merican S ociety of A nesthesiologists ( ASA ) score on early complications and survival of patients undergoing radical cystectomy for urothelial bladder cancer

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Abstract
Objective: To evaluate the impact of the preoperative A merican S ociety of A nesthesiologists ( ASA ) score and serum albumin level on complications, recurrences and survival rates of patients who underwent radical cystectomy ( RC ) for urothelial bladder cancer ( UBC ). Patients and Methods: 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 ). Results: The median (range) follow‐up was 12.4 (0.2–27.3) years. In all, 197 patients (13.4%) had a low albumin level (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). Conclusion: 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 .

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