Department of Urology, Ospedale Nuovo Legnano, Ospedale Fornaroli Magenta, Milano.
Clinical Epidemiology Unit, IRCCS Policlinico San Martino, University of Genova.
Arch Ital Urol Androl. 2021 Mar 18;93(1):15-20. doi: 10.4081/aiua.2021.1.15.
To assess the joint effect of age and comorbidities on clinical outcomes of radical cystectomy (RC).
334 consecutive patients undergoing open RC for bladder cancer (BC) during the years 2005-2015 were analyzed. Pre-, peri- and post-operative parameters, including age at RC (ARC) and Charlson Comorbidity Index (CCI), were evaluated. Overall and cancer-specific survivals (OS, CSS) were assessed by univariate and multivariate modelling. Furthermore, a three-knot restricted cubic spline (RCS) was fitted to survival data to detect dependency between death-rate ratio (HR) and ARC.
Median follow-up time was 3.8 years (IQR = 1.3-7.5) while median OS was 5.9 years (95%CL = 3.8-9.1). Globally, 180 patients died in our cohort (53.8%), 112 of which (62.2%) from BC and 68 patients (37.8%) for unrelated causes. After adjusting for preoperative, pathological and perioperative parameters, patients with CCI > 3 showed significantly higher death rates (HR = 1.61; p = 0.022). The highest death rate was recorded in ARC = 71-76 years (HR = 2.25; p = 0.034). After fitting an RCS to both OS and CSS rates, two overlapping nonlinear trends, with common highest risk values included in ARC = 70-75 years, were observed.
Age over 70 years and CCI > 3 were significant factors limiting the survival of RC and should both be considered when comparing current RC outcomes.
评估年龄和合并症对根治性膀胱切除术（RC）临床结果的联合影响。
分析了 2005 年至 2015 年间接受开放 RC 治疗膀胱癌（BC）的 334 例连续患者。评估了术前、术中和术后参数，包括 RC 时的年龄（ARC）和 Charlson 合并症指数（CCI）。通过单变量和多变量建模评估总生存率（OS）和癌症特异性生存率（CSS）。此外，还对生存数据进行了三结限制立方样条（RCS）拟合，以检测死亡率比（HR）与 ARC 之间的依赖性。
中位随访时间为 3.8 年（IQR = 1.3-7.5），中位 OS 为 5.9 年（95%CL = 3.8-9.1）。在我们的队列中，共有 180 名患者死亡（53.8%），其中 112 名（62.2%）死于 BC，68 名（37.8%）死于无关原因。在调整了术前、病理和围手术期参数后，CCI>3 的患者死亡率显著更高（HR = 1.61；p = 0.022）。ARC = 71-76 岁的患者死亡率最高（HR = 2.25；p = 0.034）。对 OS 和 CSS 率进行 RCS 拟合后，观察到两个重叠的非线性趋势，ARC = 70-75 岁时包含了共同的最高风险值。
年龄超过 70 岁和 CCI>3 是限制 RC 生存的重要因素，在比较当前 RC 结果时应同时考虑这两个因素。
