Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
Urol Oncol. 2013 May;31(4):461-7. doi: 10.1016/j.urolonc.2011.03.002. Epub 2011 Apr 16.
Comorbidity assessment may assist in the treatment choice for elderly men with prostate cancer. There is, however, no consensus on the best comorbidity classification for this purpose. In this study, we used a heuristic approach to identify an optimal comorbidity classification in elderly men selected for radical prostatectomy.
A total of 1,106 men aged 65 years or older who underwent radical prostatectomy for clinically localized prostate cancer were stratified by 11 3-sided comorbidity classifications. Overall survival was the study endpoint. The comorbidity classifications were evaluated considering 4 statistical (height of hazard ratios and P values, survival difference between high and low risk patients, dose-response relationship) and 4 clinical demands (survival rates in low and high risk group, balance of the proportion of the risk groups). The 3 best classifications in each category received 3, 2, or 1 point. After adding all points, the classification with the highest score was considered best.
With one exception, all comorbidity classifications were significant predictors of overall survival. Comparing the highest with the lowest risk group, the hazard ratios ranged between 1.67 and 3.93. Concerning the fulfillment of clinical and statistical demands, the American Society of Anesthesiologists (ASA) physical status classification and 1 derivative of it that included further more clearly defined diseases were the most promising candidates.
Stratifying candidates for radical prostatectomy according to their mortality risk using the ASA classification as a backbone supplemented by a list of more clearly defined concomitant diseases could be useful in clinical practice and outcome studies.
合并症评估可能有助于选择老年男性前列腺癌的治疗方法。然而，对于这种目的，哪种合并症分类最好尚无共识。在这项研究中，我们使用启发式方法在选择接受根治性前列腺切除术的老年男性中确定最佳合并症分类。
共有 1106 名年龄在 65 岁或以上的男性患有局限性前列腺癌，他们根据 11 种 3 面合并症分类进行分层。总体生存率是研究终点。评估了合并症分类，考虑了 4 个统计学（危险比和 P 值的高度，高风险和低风险患者之间的生存差异，剂量反应关系）和 4 个临床需求（低风险和高风险组的生存率，风险组的比例平衡）。在每个类别中得分最高的前 3 种分类得分为 3、2 或 1 分。在添加所有分数后，得分最高的分类被认为是最好的。
除了一个例外，所有合并症分类都是总生存率的显著预测因素。与最高风险组和最低风险组相比，危险比在 1.67 到 3.93 之间。关于临床和统计学需求的满足，美国麻醉医师协会（ASA）身体状况分类及其包含的进一步更明确界定的疾病的一个衍生分类是最有前途的候选者。
根据 ASA 分类作为骨干，辅以更明确界定的合并疾病清单，对接受根治性前列腺切除术的患者进行分层，根据其死亡率风险进行分层，在临床实践和结果研究中可能有用。
