衰弱和合并症对局限性前列腺癌患者手术禁忌的影响（FRART-PC 研究）。
Effect of frailty and comorbidity on surgical contraindication in patients with localized prostate cancer (FRART-PC Study).
机构信息
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
出版信息
Urol Oncol. 2021 Mar;39(3):191.e1-191.e8. doi: 10.1016/j.urolonc.2020.06.019. Epub 2020 Jul 17.
OBJECTIVES
To determine how frailty and comorbidities affect surgical contraindication in patients with localized prostate cancer (CaP).
MATERIALS AND METHODS
We evaluated the effects of frailty in 479 patients with localized CaP who were treated with robot-assisted radical prostatectomy (RARP), or radiotherapy (RT) eligible for surgery (RT-nonfrail), or those with RT ineligible for surgery due to frailty or comorbidity (RT-frail) from February 2017 to April 2020. We retrospectively compared the geriatric 8 screening (G8) scores between patients with surgical indications (RARP and RT-nonfrail groups) and those with surgical contraindications (RT-frail group). The effect of G8 score in the RT-frail groups was investigated using multivariate logistic regression analysis. We developed and validated a nomogram for surgical contraindication in patients with localized CaP.
RESULTS
The median age of patients was 70 years. There were 256, 60, and 163 patients in the RARP, RT-nonfrail, and RT-frail, respectively. The G8 score in the RARP and RT-nonfrail groups was significantly higher than in the RT-frail group (15 vs. 14, respectively, P < 0.001). Age, comorbidities (cerebrocardiovascular disease or chronic respiratory disease), and G8 score were significantly associated with the RT-frail group. The nomogram showed that the area under the curve was 0.872 and 0.923 in the training and validation sets, respectively. The cutoff for surgical contraindication was >39.5%.
CONCLUSIONS
The G8 score and comorbidities have a significant effect on surgical contraindication in patients with localized CaP.
目的
确定虚弱和合并症如何影响局限性前列腺癌（CaP）患者的手术禁忌。
材料和方法
我们评估了 479 例局限性 CaP 患者的虚弱程度，这些患者接受了机器人辅助根治性前列腺切除术（RARP）或有手术适应证的放疗（RT）（RT-非虚弱组），或因虚弱或合并症而不适合手术的 RT（RT-虚弱组），研究时间为 2017 年 2 月至 2020 年 4 月。我们回顾性比较了有手术适应证的患者（RARP 和 RT-非虚弱组）和有手术禁忌证的患者（RT-虚弱组）的老年 8 项筛查（G8）评分。采用多变量逻辑回归分析探讨 G8 评分在 RT-虚弱组中的作用。我们为局限性 CaP 患者制定并验证了手术禁忌证的列线图。
结果
患者的中位年龄为 70 岁。RARP、RT-非虚弱和 RT-虚弱组患者分别为 256、60 和 163 例。RARP 和 RT-非虚弱组的 G8 评分显著高于 RT-虚弱组（分别为 15 分和 14 分，P<0.001）。年龄、合并症（心脑血管疾病或慢性呼吸系统疾病）和 G8 评分与 RT-虚弱组显著相关。列线图显示，训练集和验证集的曲线下面积分别为 0.872 和 0.923。手术禁忌的截断值为>39.5%。
结论
G8 评分和合并症对局限性 CaP 患者的手术禁忌有显著影响。
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