Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Department of Urology and Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Prostate Cancer Prostatic Dis. 2020 Dec;23(4):573-580. doi: 10.1038/s41391-020-0225-3. Epub 2020 Mar 18.
To investigate the effect of frailty on short-term postoperative outcomes in patients with prostate cancer treated with radical prostatectomy (RP).
Within the National Inpatient Sample database, we identified 91,618 RP patients treated between 2008 and 2015. The Johns Hopkins Adjusted Clinical Groups frailty-defining indicator was applied, and we examined the rates of frailty over time, as well as its effect on overall complications, major complications, nonhome-based discharge, length of stay (LOS), and total hospital charges (THCs). Time trends and multivariable logistic, Poisson and linear regression models were applied.
Overall, 12,185 (13.3%) patients were frail. Rates of frail patients increased over time (from 10.3 to 18.2%; p < 0.001). Frail patients had higher rates of overall complications (16.6 vs. 8.6%), major complications (4.9 vs. 2.6%), nonhome-based discharge (5.9 vs. 5%), longer LOS (2 vs. 1), and higher THCs ($37,186 vs. $35,241) (all p < 0.001). Moreover, frailty was an independent predictor of overall complications (OR: 1.95), major complications (OR: 1.76), nonhome-based discharge (OR: 1.20), longer LOS (RR: 1.19), and higher THCs (RR: $3160) (all p < 0.001). Of frail patients, 10,418 (85.5%) neither exhibited body mass index ≥ 30 nor Charlson comorbidity index ≥ 2.
On average, every seventh RP patient is frail and that proportion is on the rise. Frail individuals are at higher risk of adverse short-term postoperative outcomes, that cannot be predicted by other risk factors, such as obesity or comorbidities.
研究虚弱对接受根治性前列腺切除术 (RP) 治疗的前列腺癌患者短期术后结局的影响。
在国家住院患者样本数据库中，我们确定了 2008 年至 2015 年间接受 RP 治疗的 91618 例患者。应用约翰霍普金斯调整临床组虚弱定义指标，我们检查了虚弱的发生率随时间的变化，以及其对总并发症、主要并发症、非家庭为基础的出院、住院时间 (LOS) 和总住院费用 (THCs) 的影响。应用时间趋势和多变量逻辑、泊松和线性回归模型。
总体而言，12185 例（13.3%）患者为虚弱。虚弱患者的比例随时间增加（从 10.3%增至 18.2%；p<0.001）。虚弱患者总并发症发生率较高（16.6%比 8.6%）、主要并发症发生率较高（4.9%比 2.6%）、非家庭为基础的出院率较高（5.9%比 5%）、住院时间较长（2 天比 1 天）和总费用较高（$37186 比 $35241）（均 p<0.001）。此外，虚弱是总并发症（OR：1.95）、主要并发症（OR：1.76）、非家庭为基础的出院（OR：1.20）、较长的 LOS（RR：1.19）和较高的 THCs（RR：$3160）的独立预测因素（均 p<0.001）。在虚弱患者中，10418 例（85.5%）既没有表现出 BMI≥30 也没有 Charlson 合并症指数≥2。
平均而言，每 7 例接受 RP 治疗的患者中就有 1 例虚弱，而且这一比例还在上升。虚弱患者发生不良短期术后结局的风险较高，这不能通过肥胖或合并症等其他危险因素来预测。
