Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
BJU Int. 2012 Jul;110(2):206-10. doi: 10.1111/j.1464-410X.2011.10693.x. Epub 2011 Nov 1.
Study Type - Outcomes (cohort). Level of Evidence 2b. What's known on the subject? and What does the study add? Several comorbidity classifications have been investigated for their suitability to assist treatment decision-making in men with early prostate cancer. In unselected patients, some serious comorbidities have been shown to be associated with a 10-year competing mortality rate clearly superseding the 50% level. The present study shows that it is hardly possible to discern meaningful subsets of patients with a 10-year risk of competing mortality of >50% by using comorbidity classifications. This finding suggests that the selecting clinicians did well in estimating the medium-term survival probability in men referred for radical prostatectomy.
• To identify subsets of patients who are most likely to die from competing causes ≤ 10 years after radical prostatectomy (RP).
• In all, 2205 consecutive patients who underwent RP for clinically localized prostate cancer between 1992 and 2005 were studied. The 10-year cumulative competing mortality rates were determined in several worst-case scenarios formed by using comorbidity classifications and combinations of them.
• In this sample of men selected for RP, even those with the most severe comorbidity level had a competing mortality risk of <50% ≤ 10 years after RP. • Depending on the comorbidity classification used, the 10-year cumulative competing mortality rates differed between 16 and 39% in the whole sample and between 18 and 48% in men aged ≥ 65 years.
• Clinicians do well in estimating the further life span in candidates for RP. Comorbidity classifications may assist treatment choice in this population but are not able to discern meaningful subsets to be excluded from curative treatment because of a life expectancy falling below a limit of 10 years.
研究类型-结局（队列）。证据水平 2b。主题已知内容是什么？研究新增内容是什么？已有多种合并症分类被研究，以评估其在辅助早期前列腺癌男性治疗决策中的适用性。在未经选择的患者中，一些严重的合并症与 10 年竞争死亡率显著相关，明显超过 50%的水平。本研究表明，使用合并症分类几乎不可能区分出 10 年竞争死亡率>50%的有意义的亚组患者。这一发现表明，选择进行根治性前列腺切除术的临床医生很好地估计了男性的中期生存概率。
• 确定在根治性前列腺切除术后（RP）10 年内最有可能死于竞争原因的患者亚组。
• 共研究了 1992 年至 2005 年间接受 RP 治疗局限性前列腺癌的 2205 例连续患者。使用合并症分类和它们的组合形成几种最坏情况，确定了 10 年累积竞争死亡率。
• 在选择进行 RP 的男性样本中，即使是最严重的合并症患者，在 RP 后 10 年内竞争死亡率<50%。• 根据使用的合并症分类，全组患者 10 年累积竞争死亡率在 16%至 39%之间，年龄≥65 岁的男性在 18%至 48%之间。
• 临床医生很好地估计了 RP 候选者的预期寿命。合并症分类可以辅助该人群的治疗选择，但不能区分有意义的亚组，因为预期寿命低于 10 年而排除治愈性治疗。
