Falkenbach Fabian, Rodriguez Peñaranda Natali, Longoni Mattia, Marmiroli Andrea, Le Quynh Chi, Catanzaro Calogero, Nicolazzini Michele, Lafontaine Marie-Lyssa, Tian Zhe, Goyal Jordan A, Puliatti Stefano, Schiavina Riccardo, Palumbo Carlotta, Musi Gennaro, Chun Felix K H, Briganti Alberto, Saad Fred, Shariat Shahrokh F, Budäus Lars, Graefen Markus, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg- Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.
Urol Oncol. 2025 Aug;43(8):471.e1-471.e8. doi: 10.1016/j.urolonc.2025.02.012. Epub 2025 Mar 8.
Radical prostatectomy (RP) may be a treatment option for prostate cancer patients with cirrhosis and liver disease (CLD). However, the effect of CLD on adverse in-hospital outcomes after RP has not been well described.
Descriptive analyses, propensity score matching (PSM), and multivariable logistic and Poisson regression models were used to address National Inpatient Sample RP patients between 2005 and 2019. CLD severity was stratified as mild vs. moderate/severe.
Of 191,050 RP patients, 1,559 (0.8%) had CLD. Of those, 1,515 (97.2%) vs. 44 (2.8%) were classified as having mild and moderate/severe CLD, respectively. Any CLD rate increased from 0.6% to 1.5% (2005-2019, EAPC: +7.9%, P < 0.001). CLD patients exhibited higher rates of all 15 examined adverse in-hospital outcomes. The absolute differences were largest for overall complications (+13.9%), length of stay >2 days (+8.9%), and blood transfusions (+4.0%, all P < 0.001). After detailed multivariable adjustment, CLD independently predicted higher rates of all 15 adverse in-hospital outcomes (P < 0.01). The detrimental effect was most pronounced for in-hospital mortality (multivariable odds ratio (OR) 8.74), infectious complications (OR 4.59), and hepatic complications (OR 4.45). Finally, a convincing dose-response relationship, where the effect magnitude of moderate/severe CLD was at least 3 times higher than that of mild CLD, applied in 4 of 15 comparisons.
CLD patients exhibited higher rates of adverse in-hospital outcomes after RP. However, mild CLD did not exert a prohibitive effect that would clearly preclude RP as a treatment option.
根治性前列腺切除术（RP）可能是患有肝硬化和肝病（CLD）的前列腺癌患者的一种治疗选择。然而，CLD对RP术后不良住院结局的影响尚未得到充分描述。
采用描述性分析、倾向评分匹配（PSM）以及多变量逻辑回归和泊松回归模型，对2005年至2019年全国住院患者样本中的RP患者进行分析。CLD严重程度分为轻度与中度/重度。
在191,050例RP患者中，1,559例（0.8%）患有CLD。其中，分别有1,515例（97.2%）和44例（2.8%）被归类为轻度和中度/重度CLD。任何CLD的发生率从0.6%增加到1.5%（2005 - 2019年，EAPC：+7.9%，P < 0.001）。CLD患者在所有15项检查的不良住院结局中发生率更高。总体并发症（+13.9%）、住院时间>2天（+8.9%）和输血（+4.0%，均P < 0.001）的绝对差异最大。经过详细的多变量调整后，CLD独立预测了所有15项不良住院结局的更高发生率（P < 0.01）。对住院死亡率（多变量优势比（OR）8.74）、感染性并发症（OR 4.59）和肝脏并发症（OR 4.45）的有害影响最为明显。最后，在15项比较中的4项中，存在令人信服的剂量反应关系，即中度/重度CLD的影响程度至少是轻度CLD的3倍。
CLD患者在RP术后不良住院结局的发生率更高。然而，轻度CLD并未产生明显的阻碍作用，以至于明确排除RP作为一种治疗选择。
