Department of Urology, Athens University Medical School, LAIKO Hospital, Athens, Greece.
BMC Geriatr. 2012 Apr 30;12:18. doi: 10.1186/1471-2318-12-18.
Radical cystectomy (RC) is probably underused in elderly patients due to a potential increased postoperative complication risk, as reflected by their considerable comorbidities. Our objective was to estimate the overall complication rate and investigate a potential benefit to patients over the age of 75 subjected to RC in terms of disease-free survival.
A total of 81 patients, 61 men and 20 women, from two urological departments, with a mean age of 79.2 ± 3.7 years, participated in the study. The mean follow-up period was 2.6 ± 1.6 years. All patients underwent RC with pelvic lymphadenectomy. An ileal conduit, an orthotopic ileal neobladder and cutaneous ureterostomies were formed in 48.1%, 6.2% and 45.7% of the patients, respectively. The perioperative and 90-day postoperative complications were recorded and classified according to the modified Clavien classification system. Survival plots were created based on the oncological outcome and several study parameters.
The perioperative morbidity rate was 43.2%; the 90-day morbidity rate was 37%, while the 30-day, 90-day and overall mortality rates were 3.7%, 3.7% and 21%, respectively. Overall mortality rates were recorded at the final year of data gathering (2009). Increased age, increased body mass index (BMI), longer hospitalization and age-adjusted Charlson comorbidity index (ACCI) more than six, were associated with greater hazard for 90-day morbidity. The cumulative mortality / metastasis-free rates for one, two, three and five years were 88.7%, 77.5%, 70.4%, and 62.3%, respectively. Tumour stage and positive nodes were prognostic predictors for oncological outcome.
RC in patients over 75 is justified and feasible, due to acceptable complication rates and high 5-year cancer-specific survival, which support an aggressive approach. Prospective studies are needed for the verification of the above results.
由于高龄患者合并症较多，术后并发症风险可能增加，根治性膀胱切除术（RC）的应用可能不足。我们的目的是评估整体并发症发生率，并研究 75 岁以上患者接受 RC 治疗的无病生存率是否存在潜在获益。
本研究纳入了来自两个泌尿科的 81 名患者，其中 61 名男性，20 名女性，平均年龄 79.2±3.7 岁，平均随访时间为 2.6±1.6 年。所有患者均接受 RC 联合盆腔淋巴结清扫术。48.1%、6.2%和 45.7%的患者分别形成了回肠造口术、原位回肠新膀胱和皮输尿管造口术。根据改良 Clavien 分类系统记录并分类了围手术期和 90 天术后并发症。根据肿瘤学结果和多个研究参数创建了生存图。
围手术期发病率为 43.2%；90 天发病率为 37%，而 30 天、90 天和总死亡率分别为 3.7%、3.7%和 21%。总死亡率是在数据收集的最后一年（2009 年）记录的。高龄、体重指数（BMI）增加、住院时间延长和年龄调整 Charlson 合并症指数（ACCI）超过 6 与 90 天发病率增加的风险更大相关。1、2、3 和 5 年的累积死亡率/无转移生存率分别为 88.7%、77.5%、70.4%和 62.3%。肿瘤分期和阳性淋巴结是肿瘤学结果的预后预测因子。
RC 治疗 75 岁以上患者是合理且可行的，因为其并发症发生率可接受，5 年癌症特异性生存率高，支持采用积极的治疗方法。需要前瞻性研究来验证上述结果。
