Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada; Institut du Cancer de Montréal, Montréal, Québec, Canada; Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada; Institut du Cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Eur Urol. 2018 Dec;74(6):693-696. doi: 10.1016/j.eururo.2018.07.006. Epub 2018 Jul 20.
Cytoreductive radical prostatectomy (CRP) may offer a survival advantage, according to several retrospective analyses. However, few data are available regarding the morbidity of radical prostatectomy in the metastatic setting. We addressed intra- and postoperative complications of CRP relative to radical prostatectomy for nonmetastatic prostate cancer (nmRP). Within the National Inpatient Sample database (2008-2013), we identified patients who underwent CRP versus nmRP. Propensity score matching to reduce the effect of inherent differences between CRP and nmRP patients, multivariable logistic regression models, Poisson regression models, and linear regression models were used. Of 76 378 patients, 1.2% (n=953) underwent CRP. CRP resulted in higher rates of overall (odds ratio [OR]: 1.34, p=0.01), intraoperative (OR: 2.61, p=0.005), and miscellaneous surgical complications (OR: 1.69, p=0.02). Moreover, CRP was associated with longer stay (OR: 1.07, p=0.01) and higher total hospital charges ($810 more per surgery, p=0.0004). Intra- and postoperative complications associated with CRP are higher than those of nmRP. Similarly, an increase in total hospital charges is associated with CRP. Nonetheless, CRP complication profile validates its safety and feasibility. PATIENT SUMMARY: In this population-based study, we recorded higher intra- and postoperative complications rates for CRP versus nmRP. Nonetheless, CRP complication rates appear manageable but require explicit discussion at counseling.
根治性前列腺切除术（CRP）可能具有生存优势，这是几项回顾性分析的结果。然而，转移性前列腺癌患者接受根治性前列腺切除术的发病率数据有限。我们分析了转移性和非转移性前列腺癌患者接受 CRP 和根治性前列腺切除术的围手术期并发症。我们在国家住院患者样本数据库（2008-2013 年）中，识别出接受 CRP 和 nmRP 的患者。通过倾向评分匹配来降低 CRP 和 nmRP 患者固有差异的影响，使用多变量逻辑回归模型、泊松回归模型和线性回归模型。在 76378 名患者中，1.2%（n=953）接受了 CRP。CRP 导致总体并发症（比值比 [OR]：1.34，p=0.01）、术中并发症（OR：2.61，p=0.005）和其他手术并发症（OR：1.69，p=0.02）的发生率更高。此外，CRP 与住院时间延长（OR：1.07，p=0.01）和总住院费用增加（每例手术增加 810 美元，p=0.0004）相关。与 nmRP 相比，CRP 相关的围手术期并发症更高。同样，总住院费用的增加与 CRP 相关。然而，CRP 的并发症情况验证了其安全性和可行性。患者总结：在这项基于人群的研究中，我们记录了 CRP 与 nmRP 相比，围手术期并发症发生率更高。然而，CRP 的并发症发生率似乎是可控的，但需要在咨询时进行明确讨论。
