Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Department of Medical Statistics and Biometry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Eur Urol. 2017 May;71(5):710-713. doi: 10.1016/j.eururo.2016.10.022. Epub 2016 Oct 25.
Estimating the risk of competing mortality is of importance in tailoring optimal individual management strategies in patients with early prostate cancer. Using proportional hazard models for competing risks, we determined which parameters predict competing mortality in patients selected for radical prostatectomy aged 70 yr or older and compared the prognostic impact of individual parameters with that of their younger counterparts. Three common diseases (diabetes mellitus, chronic lung disease, and other cancer) that predicted competing mortality in younger men were not predictors of competing mortality in men selected for radical prostatectomy aged 70 yr or older (hazard ratio [HR]:<1). Besides age (HR/yr: 1.08, p=0.0255), peripheral vascular disease (HR: 2.33, p=0.0195), cerebrovascular disease (HR: 2.23, p=0.0242), American Society of Anesthesiologists physical status class 3 (HR: 2.19, p<0.0001), current smoking (HR: 2.18, p=0.0098), and lower or unknown level of education (HR: 2.07, p=0.0002) were independent predictors of competing mortality in patients aged 70 yr or older. Combining these five conditions in a score might provide a superior comorbidity measure in this particular population.
Stricter selection may diminish the prognostic significance of several common diseases in men selected for radical prostatectomy aged 70 yr or older whereas other parameters (peripheral vascular disease, cerebrovascular disease, American Society of Anesthesiologists physical status class 3, current smoking, and level of education) sustained their meaningfulness and should be taken into consideration when the risk of competing mortality is estimated.
在制定早期前列腺癌患者的最佳个体化管理策略时，估计竞争死亡率的风险很重要。我们使用竞争风险比例风险模型，确定了哪些参数可以预测选择接受根治性前列腺切除术的 70 岁或以上患者的竞争死亡率，并将单个参数的预后影响与年轻患者的预后影响进行了比较。在年轻男性中预测竞争死亡率的三种常见疾病（糖尿病、慢性肺部疾病和其他癌症）并非选择接受根治性前列腺切除术的 70 岁或以上男性竞争死亡率的预测因素（风险比[HR]：<1）。除年龄（HR/yr：1.08，p=0.0255）外，外周血管疾病（HR：2.33，p=0.0195）、脑血管疾病（HR：2.23，p=0.0242）、美国麻醉医师协会身体状况 3 级（HR：2.19，p<0.0001）、当前吸烟（HR：2.18，p=0.0098）和较低或未知的教育程度（HR：2.07，p=0.0002）也是 70 岁或以上患者竞争死亡率的独立预测因素。将这五个条件组合成一个评分可能会为该特定人群提供更好的合并症衡量标准。
在选择接受根治性前列腺切除术的 70 岁或以上男性中，严格的选择可能会降低几种常见疾病的预后意义，而其他参数（外周血管疾病、脑血管疾病、美国麻醉医师协会身体状况 3 级、当前吸烟和教育程度）则保持其重要性，在估计竞争死亡率风险时应考虑这些因素。
