Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and 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 Focus. 2020 Nov 15;6(6):1213-1219. doi: 10.1016/j.euf.2018.12.006. Epub 2018 Dec 26.
Radical prostatectomy (RP) represents one standard of care for patients with localized prostate cancer and is associated with several established postoperative complications.
We tested the relationship between RP early postoperative outcomes and age within a population-based data repository.
DESIGN, SETTING, AND PARTICIPANTS: Within the National Inpatient Sample database (2008-2013), we identified patients who underwent robotically assisted or open RP.
Multivariable logistic regression (MLR), multivariable Poisson regression (MPR), and linear regression models were used. Cubic spline graphically depicted the relationship between age and complications.
Overall, 68780 patients underwent RP with a median age of 62 yr (interquartile range: 57-67 yr). In MLR models, patient age represented an independent predictor of overall [odds ratio (OR): 1.02, p<0.001], intraoperative (OR: 1.03, p<0.001), cardiac (OR: 1.03, p<0.001), miscellaneous medical (OR: 1.02, p<0.001), miscellaneous surgical (OR: 1.01, p=0.01), pulmonary (OR: 1.02, p<0.001), and vascular complications (OR: 1.05, p<0.001); blood transfusions (OR: 1.02, p<0.001); and bowel obstruction (OR: 1.02, p<0.001). In MPR models, patient age was associated with longer stay (OR: 1.001, p=0.02). Similar results were recorded after adjustment for clustering in stratified analyses (<70 vs ≥70 yr) and in the subgroup of patients that underwent robotically assisted RP. For nine out of twelve examined outcomes, a virtually direct relationship existed with increasing age, in cubic spline analyses.
Virtually all early postoperative RP complications are directly related to age. In consequence, these observations should be considered from an individual patient perspective as well as from a health management perspective.
RP is provided through a wide patient age spectrum. Virtually all early postoperative RP complications are directly related to age. Individual patient's age needs to be considered in treatment decision-making.
根治性前列腺切除术（RP）是治疗局限性前列腺癌的标准治疗方法之一，与多种已确立的术后并发症相关。
我们在一个基于人群的数据库中检验 RP 术后早期结局与年龄之间的关系。
设计、设置和参与者：在国家住院患者样本数据库（2008-2013 年）中，我们确定了接受机器人辅助或开放性 RP 的患者。
采用多变量逻辑回归（MLR）、多变量泊松回归（MPR）和线性回归模型。三次样条图直观地描绘了年龄与并发症之间的关系。
总体而言，68780 例患者接受了 RP，中位年龄为 62 岁（四分位间距：57-67 岁）。在 MLR 模型中，患者年龄是总体并发症的独立预测因素[比值比（OR）：1.02，p<0.001]、术中并发症（OR：1.03，p<0.001）、心脏并发症（OR：1.03，p<0.001）、其他内科并发症（OR：1.02，p<0.001）、其他外科并发症（OR：1.01，p=0.01）、肺部并发症（OR：1.02，p<0.001）和血管并发症（OR：1.05，p<0.001）；输血（OR：1.02，p<0.001）；和肠阻塞（OR：1.02，p<0.001）。在 MPR 模型中，患者年龄与住院时间延长相关（OR：1.001，p=0.02）。在分层分析（<70 岁与≥70 岁）和接受机器人辅助 RP 的患者亚组中进行调整后，也记录到了类似的结果。在三次样条分析中，对于十二项检查结果中的九项，年龄与并发症之间存在直接关系。
RP 术后几乎所有早期并发症都与年龄直接相关。因此，这些观察结果应从个体患者的角度以及从健康管理的角度来考虑。
RP 适用于广泛的患者年龄范围。RP 术后几乎所有早期并发症都与年龄直接相关。在治疗决策中需要考虑患者的年龄。
