Selvi Ismail, Arik Ali Ihsan, Baydilli Numan, Basay Mehmet Sinan, Basar Halil
Başakşehir Çam ve Sakura City Hospital, Department of Urology, Istanbul, Turkey.
Health Science University, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Urology, Ankara, Turkey.
Cent European J Urol. 2021;74(1):24-38. doi: 10.5173/ceju.2021.0246. Epub 2021 Mar 5.
We aimed to evaluate the superiority of different comorbidity indices in determining the most suitable elderly male candidates for uro-oncological operations. While making this assessment, we also aimed to determine the risk factors that may affect surgery-related major complications and overall survival.
Data of 543 male patients, 60 years or older, who underwent uro-oncological surgery (radical cystectomy, radical prostatectomy, radical or partial nephrectomy, transurethral resection of bladder tumor) between September 2009 and January 2019 were retrospectively evaluated. Demographic, clinical and pathological characteristics of the patients, preoperative comorbidity indices, postoperative complications, length of hospitalization, re-admission rates within 90 days and postoperative follow-up outcomes were recorded. Patients in similar tumor stages were divided into different subgroups. All subgroups were divided into two main categories: middle age (60-69 years-old) and elderly age (≥70-years-old).
No significant difference was found for all types of surgery in terms of postoperative outcomes in both age groups (p >0.05). Age-adjusted Charlson Comorbidity Index (ACCI), Preoperative Score to Predict Postoperative Mortality (POSPOM), Rockwood Frailty Index (RFI) and tumor characteristics were found to be more significant predictors for postoperative major complications and overall mortality than Eastern Cooperative Oncology Group (ECOG), American Society of Anesthesiologists (ASA) and New York Heart Association (NYHA) functional classification.
Our findings show that patient age alone is not a risk factor for increased postoperative complications and overall mortality. Although many different comorbidity indices have been used in urological practice, ACCI, POSPOM and RFI are more valuable predictors. Uro-oncological surgeries may be performed safely in elderly males after a good clinical decision based on these indices.
我们旨在评估不同合并症指数在确定最适合接受泌尿肿瘤手术的老年男性患者方面的优越性。在进行此项评估时，我们还旨在确定可能影响手术相关重大并发症和总生存期的风险因素。
回顾性评估了2009年9月至2019年1月期间接受泌尿肿瘤手术（根治性膀胱切除术、根治性前列腺切除术、根治性或部分肾切除术、经尿道膀胱肿瘤切除术）的543例60岁及以上男性患者的数据。记录了患者的人口统计学、临床和病理特征、术前合并症指数、术后并发症、住院时间、90天内再入院率以及术后随访结果。将处于相似肿瘤分期的患者分为不同亚组。所有亚组分为两个主要类别：中年（60 - 69岁）和老年（≥70岁）。
在两个年龄组中，所有类型手术的术后结果均未发现显著差异（p>0.05）。与东部肿瘤协作组（ECOG）、美国麻醉医师协会（ASA）和纽约心脏协会（NYHA）功能分级相比，年龄调整后的查尔森合并症指数（ACCI）、预测术后死亡率的术前评分（POSPOM）、罗克伍德衰弱指数（RFI）和肿瘤特征被发现是术后重大并发症和总死亡率更显著的预测因素。
我们的研究结果表明，仅患者年龄并非术后并发症增加和总死亡率升高的风险因素。尽管泌尿外科实践中使用了许多不同的合并症指数，但ACCI、POSPOM和RFI是更有价值的预测指标。基于这些指数做出良好的临床决策后，老年男性可以安全地进行泌尿肿瘤手术。
