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Blezien O, Bentellis I, Tibi B, Shaikh A, Rambaud C, Boulahssass R, De Cobelli O, Chevallier D, Ahallal Y, Durand M. Robot assisted radical prostatectomy in fit older patients compared to a standard population: Clinical characteristics, surgical, oncological and functional outcomes. Prog Urol 2023; 33:272-278. [PMID: 36764858 DOI: 10.1016/j.purol.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION To compare robotic assisted radical prostatectomy (RARP) in well-selected older patients with clinically localized prostate cancer, compared to a younger population. Primary endpoint was perioperative outcomes comparison and secondary endpoint were oncological and functional outcomes comparison to a younger population. METHODS Single tertiary center cohort of consecutive patients treated with RARP (2017-2020) with retrospective analysis. Patients were classified by age in two groups: <75: control group (CG) and ≥75: study group (SG). Patients aged ≥75 had a comprehensive geriatric assessment (CGA) and only patients classified Balducci ≤2 were admitted to surgery. RESULTS Two hundred and sixty-nine patients were included, 56 in SG and 213 in CG. Median follow-up was 9.8 months. Univariate analysis showed no statistically significant (SS) difference between the groups for patients' characteristics (PSA, digital rectal examination -DRE- and biopsy Gleason Score), perioperative data (operative time, hospitalization length, transfusions rate, immediate complications, Clavien-Dindo complications, 30-days re-interventions and 30-days re-hospitalisation), oncological (TNM, margins, extraprostatic extension, postoperative PSA, BCR, metastases, overall survival -OS- and cancer specific survival -CSS-) and functional outcomes. Median perioperative blood loss was lower in the SG: 200.00 cc IQR [100.00, 300.00] vs 200.00cc IQR [100.00, 400.00] in the CG (P<0.05). A multivariate regression considering age>75, DRE, GS, PSA, cardiovascular history and diabetes showed none of variables associated with early BCR. Limitations are retrospective design, small number of patients and short follow-up. CONCLUSIONS RARP shows similar perioperative, oncologic and functional outcomes for older patients selected by a CGA when compared to younger patients. The SG shows a minor perioperative bleeding. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- O Blezien
- Università degli Studi di Milano, Urology Department - Istituto Europeo di Oncologia, Milano, Italy; Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France.
| | - I Bentellis
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - B Tibi
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - A Shaikh
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - C Rambaud
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est, CHU de Nice, France
| | - R Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est, CHU de Nice, France; FHU Oncoage, Nice, France
| | - O De Cobelli
- Università degli Studi di Milano, Urology Department - Istituto Europeo di Oncologia, Milano, Italy
| | - D Chevallier
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - Y Ahallal
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - M Durand
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France; INSERM U108, CNRS UMR 7284, Nice University Côte d'Azur, France
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Haggart R, Polter E, Ross M, Kohli N, Konety BR, Mitteldorf D, West W, Rosser BRS. Comorbidity Prevalence and Impact on Quality of Life in Gay and Bisexual Men Following Prostate Cancer Treatment. Sex Med 2021; 9:100439. [PMID: 34634579 PMCID: PMC8766256 DOI: 10.1016/j.esxm.2021.100439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Studies have demonstrated worse health related quality of life (HRQOL) outcomes in gay and bisexual men (GBM) following prostate cancer treatment compared to heterosexual men potentially due to differences in comorbidity burden. Aim To establish the prevalence of comorbidities and their association with HRQOL metrics in GBM following prostate cancer treatment. Methods We evaluated HRQOL and prevalence of comorbidities in 193 GBM from the United States and Canada in a cross-sectional, online survey: the Masked for Review. HRQOL was measured with the Expanded Prostate Cancer Index Composite (EPIC) and the 12-Item Short Form Health Survey (SF-12). Main Outcome Measures Our outcomes included comorbidity prevalence, mean differences for HRQOL scores by comorbidity status, and mean differences for HRQOL by comorbidity count. Results GBM were found to have a higher prevalence of blood vessel disease and mental health disorders but lower prevalence of obesity and type 2 diabetes when compared to published data in general prostate cancer populations. Statistically significant reductions in HRQOL metrics were associated with mental health diagnoses, diabetes, and obesity. Increased number of comorbidities was also associated with reductions in HRQOL metrics in nearly all categories. Conclusion These results suggest that the worse QOL outcomes in GBM following prostate cancer treatment may be due to differences in comorbidity burden. This study is the first to evaluate the relationship between comorbidities and HRQOL outcomes in GBM. Limitations of this study include a small sample size and cross-sectional study design. If confirmed in larger, longitudinal, clinically confirmed studies, these findings indicate a need to intervene on and consider comorbidities in GBM diagnosed with prostate cancer. Haggart R, Polter E, Ross M, et al. Comorbidity Prevalence and Impact on Quality of Life in Gay and Bisexual Men Following Prostate Cancer Treatment. Sex Med 2021;9:100439.
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Affiliation(s)
- Ryan Haggart
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.
| | - Elizabeth Polter
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Michael Ross
- Department of Family Medicine & Community Health, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Nidhi Kohli
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | | | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, MN, USA
| | - B R Simon Rosser
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Selvi I, Arik AI, Baydilli N, Basay MS, Basar H. Evaluation of comorbidity indices in determining the most suitable candidates for uro-oncological surgeries in elderly men. Cent European J Urol 2021; 74:24-38. [PMID: 33976912 PMCID: PMC8097655 DOI: 10.5173/ceju.2021.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/01/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction 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. Material and methods 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). Results 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. Conclusions 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.
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Affiliation(s)
- Ismail Selvi
- Başakşehir Çam ve Sakura City Hospital, Department of Urology, Istanbul, Turkey
| | - Ali Ihsan Arik
- Health Science University, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Numan Baydilli
- Erciyes University Medical School, Department of Urology, Kayseri, Turkey
| | - Mehmet Sinan Basay
- Health Science University, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Halil Basar
- Health Science University, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Urology, Ankara, Turkey
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Cai H, Zhang Y, Liu X, Jiang W, Chen Z, Li S, Guan G. Association of age and cause-special mortality in patients with stage I/ II colon cancer: A population-based competing risk analysis. PLoS One 2020; 15:e0240715. [PMID: 33064784 PMCID: PMC7567365 DOI: 10.1371/journal.pone.0240715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/02/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study aimed to determine the probability and prognostic factors of colon cancer-specific mortality (CCSM) and noncancer-specific mortality (NCSM) for patients with stage I/II colon cancer and evaluate the association of age on cause-specific mortality. MATERIALS AND METHODS From Surveillance, Epidemiology, and End Results (SEER) database, we identified 33152 patients with stage I/II colon cancer undergoing surgery between 2004 and 2011. The cumulative incidence of CCSM and NCSM was calculated, and competing risk analysis was performed to investigate prognostic factors for cause-specific mortality. RESULTS In patients <50, 50-75, and >75 years of age, 5-year cumulative incidence of CCSM was 5.7%, 7.8%, and 16.1%, respectively (overall, 10.6%); 5-year cumulative incidence of NCSM was 2.2%, 7.1%, and 26.9%, respectively (overall, 13.8%). The probability of CCSM and NCSM increased with advanced age. The 5-year cumulative incidence of CCSM was higher than NCSM in patients <50 years of age, whereas lower in patients >75 years of age. The probability of CCSM and NCSM was similar in patients 50-75 years of age. Competing-risk multivariable analysis demonstrated that increasing age was a strong predictor of CCSM (per year increase, SHR 1.03,95% confidence interval [CI]: 1.03-1.04). Age was most predictive of NCSM: (per year increase, SHR 1.08, 95% CI: 1.08-1.08). CONCLUSION Age was significantly associated with an increased cumulative incidence of CCSM and NCSM of patients with stage I/II colon cancer underwent surgery. NCSM was a significant competing event and should be adequately considered when performing survival analysis.
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Affiliation(s)
- Huajun Cai
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yiyi Zhang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xing Liu
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Weizhong Jiang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhifen Chen
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shoufeng Li
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guoxian Guan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- * E-mail:
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Predictive Value of the Age-Adjusted Charlson Comorbidity Index for Outcomes After Hepatic Resection of Hepatocellular Carcinoma. World J Surg 2020; 44:3901-3914. [PMID: 32651603 DOI: 10.1007/s00268-020-05686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the impact of the age-adjusted Charlson comorbidity index (ACCI) on outcomes after hepatic resection for hepatocellular carcinoma (HCC). METHODS We assessed 763 patients who underwent hepatic resection for HCC. The ACCI scores were categorized as follows: ACCI ≤ 5, ACCI = 6, and ACCI ≥ 7. RESULTS A multivariate analysis showed that the odds ratios for postoperative complications in ACCI = 6 and ACCI ≥ 7 groups, with reference to ACCI ≤ 5 group, were 0.71 (p = 0.41) and 4.15 (p < 0.001), respectively. The hazard ratios for overall survival of ACCI = 6 and ACCI ≥ 7 groups, with reference to ACCI ≤ 5 group, were 1.52 (p = 0.023) and 2.45 (p < 0.001), respectively. The distribution of deaths due to HCC-related, liver-related, and other causes was 68.2%, 11.8%, and 20% in ACCI ≤ 5 group, 47.2%, 13.9%, and 38.9% in ACCI = 6 group, and 27.3%, 9.1%, and 63.6% in ACCI ≥ 7 group (p = 0.053; ACCI ≤ 5 vs. = 6, p = 0.19; ACCI = 6 vs. ≥ 7, p < 0.001; ACCI ≤ 5 vs. ≥ 7). In terms of the treatment for HCC recurrence in ACCI ≤ 5, ACCI = 6, and ACCI ≥ 7 groups, adaptation rate of surgical resection was 20.1%, 7.3%, and 11.1% and the rate of palliative therapy was 4.3%, 12.2%, and 22.2%, respectively. CONCLUSIONS The ACCI predicted the short-term and long-term outcomes after hepatic resection of HCC. These findings will help physicians establish a treatment strategy for HCC patients with comorbidities.
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