Huang Haiwen, Zhang Zhenan, Hao Han, Wang Haixin, Shang Meixia, Xi Zhijun
Department of Urology, Peking University First Hospital, Beijing, China.
Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Front Oncol. 2022 Oct 20;12:1002110. doi: 10.3389/fonc.2022.1002110. eCollection 2022.
Lack of assessment of 90-d perioperative morbidity in elderly patients after radical cystectomy and pelvic lymph node dissection (PLND) using a standard reporting methodology, and the Clavien-Dindo classification (CDC) does not accurately reflect the burden of complications. We aim to report the 90-d complications of elderly patients after radical cystectomy, and to compare the validity of the Comprehensive Complication Index (CCI) and CDC.
Retrospective review of 280 patients aged ≥75 years who received radical cystectomy between 2006 and 2021. The 90-d complications of elderly patients after radical cystectomy were reported by implementing the EAU criteria. The CDC and CCI were both used for grading complications. The Spearman rank correlation coefficient was used to estimate the correlation between postoperative stay and CDC/CCI. Logistic regression was used to identify the risk factors for major complications. The sample size for a fictive superiority trial was calculated for different endpoints.
A total of 225 (80.36%) patients suffered from 528 complications. The cumulative CCI had a more accurate prediction of postoperative stay than the CDC (r = 0.378, p < 0.001 vs. r = 0.349, p < 0.001). The need for sample size could decrease when CCI was used for the primary endpoint. More risk factors for major complications were identified when CCI ≥33.7 was defined as the endpoint of major complications.
CCI is better than CDC for grading the severity of complications in elderly patients after radical cystectomy and PLND.
缺乏使用标准报告方法对老年患者根治性膀胱切除术和盆腔淋巴结清扫术（PLND）后90天围手术期发病率进行评估，且Clavien-Dindo分类法（CDC）不能准确反映并发症负担。我们旨在报告老年患者根治性膀胱切除术后90天的并发症情况，并比较综合并发症指数（CCI）和CDC的有效性。
回顾性分析2006年至2021年间接受根治性膀胱切除术的280例年龄≥75岁的患者。通过实施欧洲泌尿外科学会（EAU）标准报告老年患者根治性膀胱切除术后90天的并发症。CDC和CCI均用于并发症分级。采用Spearman等级相关系数估计术后住院时间与CDC/CCI之间的相关性。采用逻辑回归确定主要并发症的危险因素。针对不同终点计算虚拟优效性试验的样本量。
共有225例（80.36%）患者出现528例并发症。与CDC相比，累积CCI对术后住院时间的预测更准确（r = 0.378，p < 0.001 vs. r = 0.349，p < 0.001）。当将CCI用于主要终点时，所需样本量可能会减少。当将CCI≥33.7定义为主要并发症终点时，可识别出更多主要并发症的危险因素。
在对老年患者根治性膀胱切除术和PLND术后并发症严重程度进行分级方面，CCI优于CDC。
