膀胱癌虚弱患者根治性膀胱切除术的近期和远期效果。

The Short- and Long-Term Effect of Radical Cystectomy in Frail Patients With Bladder Cancer.

机构信息

Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany.

出版信息

Clin Genitourin Cancer. 2023 Aug;21(4):e291-e298. doi: 10.1016/j.clgc.2023.03.004. Epub 2023 Mar 11.

DOI:10.1016/j.clgc.2023.03.004

PMID:37032231

Abstract

BACKGROUND

Studies about perioperative complications and all-cause mortality in frail patients requiring radical cystectomy (RC) are scarce. We aimed to assess the short- and long-term effect of RC in frail patients with bladder cancer.

PATIENTS AND METHODS

We performed a retrospective, cohort study including patients who underwent open RC due to bladder cancer from November 2013 to June 2022. Patients were considered frail when they fulfilled one of the following criteria: i) age ≥ 75 years; ii) Charlson Comorbidity Index ≥ 9; iii) American Society of Anesthesiologists classification ≥ 4; or iv) Clinical Frailty Scale score ≥ 5. We evaluated all-cause mortality and complications in frail versus nonfrail patients. The effect of urinary diversion with ileal conduit versus ureterocutaneostomy in frail patients was also assessed via a Cox regression analysis.

RESULTS

Overall, 184 individuals underwent RC (95 frail and 89 nonfrail). A total of 130 patients (80%) presented at least one perioperative complication. This proportion was even higher among frail patients (86%). Similarly, severe perioperative complications were more common in frail patients based on the Clavien-Dindo classification (P = 0.044). Regarding disease progression and long-term complications, no statistically significant differences were observed between frail and nonfrail patients. The survival analysis with Kaplan-Meier curves demonstrated that the risk of death was increased in frail patients (log-rank test = 0.027). Based on the multivariate Cox regression analysis adjusting for major risk factors, urinary diversion with ureterocutaneostomy was significantly associated with increased mortality in frail patients compared to ileal conduit (Hazard Ratio: 3.5, 95% Confidence Interval: 1.3-9.4, P = 0.01).

CONCLUSIONS

RC is feasible in frail patients but is associated with increased perioperative morbidity and mortality. Preoperative frailty screening should be implemented to counsel and carefully select patients eligible for RC.

摘要

背景

关于需要根治性膀胱切除术 (RC) 的虚弱患者的围手术期并发症和全因死亡率的研究很少。我们旨在评估 RC 对患有膀胱癌的虚弱患者的短期和长期效果。

患者和方法

我们进行了一项回顾性队列研究，纳入了 2013 年 11 月至 2022 年 6 月期间因膀胱癌接受开放 RC 的患者。当患者符合以下标准之一时，被认为是虚弱的：i）年龄≥75 岁；ii）Charlson 合并症指数≥9；iii）美国麻醉医师协会分级≥4；或 iv）临床虚弱量表评分≥5。我们评估了虚弱患者与非虚弱患者的全因死亡率和并发症。还通过 Cox 回归分析评估了在虚弱患者中使用回肠导管与输尿管皮造口术的尿流改道效果。

结果

总体而言，有 184 人接受了 RC（95 名虚弱患者和 89 名非虚弱患者）。共有 130 名患者（80%）至少出现了一次围手术期并发症。虚弱患者的这一比例甚至更高（86%）。同样，根据 Clavien-Dindo 分类，虚弱患者更常见严重的围手术期并发症（P=0.044）。关于疾病进展和长期并发症，虚弱患者与非虚弱患者之间没有统计学上的显著差异。Kaplan-Meier 曲线的生存分析表明，虚弱患者的死亡风险增加（对数秩检验=0.027）。基于多因素 Cox 回归分析，调整主要危险因素后，与回肠导管相比，输尿管皮造口术与虚弱患者的死亡率增加显著相关（危险比：3.5，95%置信区间：1.3-9.4，P=0.01）。