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Yajima S, Nakanishi Y, Ogasawara RA, Imasato N, Hirose K, Katsumura S, Kataoka M, Masuda H. Comparing Preoperative Screening Tools for Elective Urologic Cancer Surgery: Insights from a Cluster Analysis. Gerontology 2024; 70:741-754. [PMID: 38583416 DOI: 10.1159/000538733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/31/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the features and benefits of different geriatric screening tools for enhancing the perioperative care of patients who undergo elective cancer surgery using cluster analysis. METHODS This study was a retrospective, observational analysis of 1,019 consecutive patients who had elective major cancer surgery in the urology department of our hospital from October 2019 to January 2023. Before the surgery, a trained nurse screened the patients using six tools: Eastern Clinical Oncology Group performance status (ECOG-PS), flemish version of the triage risk screening tool (fTRST), geriatric-8 (G8), instrumental activities of daily living, patient health questionnaire-2 (PHQ-2), and simple questionnaire to rapidly diagnose sarcopenia (SARC-F). The study grouped the patients into four clusters based on their scores on these tools and compared their outcomes after the surgery. The outcomes included overall survival, ambulation failure, delirium, and severe complications. The study also examined how each screening tool was associated with the outcomes. RESULTS Based on their clinical data and screening results, we classified the patients into four groups: Healthy (73%), Depressive (11%), Intermediate (11%), and Unhealthy (5%). The Unhealthy group had the worst outcomes in overall survival (OS), ambulation failure, and delirium, followed by the Intermediate group. In addition, fTRST and SARC-F emerged as significant predictors of OS; ECOG-PS, fTRST, G8, and SARC-F of ambulation failure; ECOG-PS, fTRST, and G8 of delirium; and G8 of severe complications. CONCLUSION Various geriatric screening tools were found to have the potential to forecast diverse postoperative outcomes.
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Affiliation(s)
- Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yasukazu Nakanishi
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ryo Andy Ogasawara
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naoki Imasato
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kohei Hirose
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Sao Katsumura
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Madoka Kataoka
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
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Sletten R, Berger Christiansen O, Oldervoll LM, Åstrøm L, Kjesbu Skjellegrind H, Šaltytė Benth J, Kirkevold Ø, Bergh S, Grønberg BH, Rostoft S, Bye A, Mork PJ, Slaaen M. The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study. Scand J Urol 2024; 59:31-38. [PMID: 38379397 DOI: 10.2340/sju.v59.18616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects. MATERIAL AND METHODS This single-center, cross-sectional study included men treated for localized prostate cancer with robotic-assisted radical prostatectomy (RARP) or external beam radiotherapy (EBRT) in 2014-2018. Global QoL and PF were assessed by the European Organisation of Research and Treatment in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite (EPIC-26). Adjusted linear regression models were estimated to assess associations between age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment. RESULTS Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT combined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min-max 44-84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coefficient [RC] -0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly poorer than age-adjusted normative scores, for men <70 years (n = 411) as well as for men ≥70 years (n = 243) at treatment, but the differences were not beyond clinical significance. CONCLUSIONS In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.
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Affiliation(s)
- Reidun Sletten
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Department of Oncology and Palliative Care, Innlandet Hospital Trust, Gjøvik/Lillehammer, Norway; Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Ola Berger Christiansen
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Department of Urology, Innlandet Hospital Trust, Hamar, Norway
| | - Line Merethe Oldervoll
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Centre for Crisis Psychology, Faculty of Psychology University of Bergen, Bergen, Norway
| | - Lennart Åstrøm
- Section of Clinical and Experimental Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Håvard Kjesbu Skjellegrind
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jūratė Šaltytė Benth
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Øyvind Kirkevold
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Faculty of Health, Care and Nursing, NTNU Gjøvik, Gjøvik, Norway; The Norwegian National Centre for Ageing and Health, Tønsberg, Norway
| | - Sverre Bergh
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; The Norwegian National Centre for Ageing and Health, Tønsberg, Norway
| | - Bjørn Henning Grønberg
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway; Department of Oncology, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Siri Rostoft
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Asta Bye
- Oslo Metropolitan University, Oslo, Norway
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marit Slaaen
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Koelker M, Labban M, Frego N, Meyer CP, Salomon G, Lipsitz SR, Withington J, Moore CM, Tempany CM, Tuncali K, George A, Kibel AS, Trinh QD, Cole AP. Contemporary patterns of local ablative therapies for prostate cancer at United States cancer centers: results from a national registry. World J Urol 2023; 41:1309-1315. [PMID: 36930254 PMCID: PMC10506077 DOI: 10.1007/s00345-023-04354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/26/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To describe the national-level patterns of care for local ablative therapy among men with PCa and identify patient- and hospital-level factors associated with the receipt of these techniques. METHODS We retrospectively interrogated the National Cancer Database (NCDB) for men with clinically localized PCa between 2010 and 2017. The main outcome was receipt of local tumor ablation with either cryo- or laser-ablation, and "other method of local tumor destruction including high-intensity focused ultrasound (HIFU)". Patient level, hospital level, and demographic variables were collected. Mixed effect logistic regression models were fitted to identify separately patient- and hospital-level predictors of receipt of local ablative therapy. RESULTS Overall, 11,278 patients received ablative therapy, of whom 78.8% had cryotherapy, 15.6% had laser, and 5.7% had another method including HIFU. At the patient level, men with intermediate-risk PCa were more likely to be treated with local ablative therapy (OR 1.05; 95% CI 1.00-1.11; p = 0.05), as were men with Charlson Comorbidity Index > 1 (OR 1.36; 95% CI 1.29-1.43; p < 0.01), men between 71 and 80 years (OR 3.70; 95% CI 3.43-3.99; p < 0.01), men with Medicare insurance (OR 1.38; 95% 1.31-1.46; p < 0.01), and an income < $47,999 (OR 1.16; 95% CI 1.06-1.21; p < 0.01). At the hospital-level, local ablative therapy was less likely to be performed in academic/research facilities (OR 0.45; 95% CI 0.32-0.64; p < 0.01). CONCLUSIONS Local ablative therapy for PCa treatment is more commonly offered among older and comorbid patients. Future studies should investigate the uptake of these technologies in non-hospital-based settings and in light of recent changes in insurance coverage.
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Affiliation(s)
- Mara Koelker
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Muhieddine Labban
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Nicola Frego
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
- Department of Urology, Humanitas Research Hospital-IRCCS, Rozzano, Milan, Italy
| | - Christian P Meyer
- Department of Urology, Ruhr University Bochum, Klinikum Herford, Herford, Germany
| | - Georg Salomon
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stuart R Lipsitz
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - John Withington
- Division of Surgical and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals Trust, London, UK
| | - Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Arvin George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Adam S Kibel
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Alexander P Cole
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA.
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Robot-assisted radical prostatectomy in indian men of age 75 years and above: a propensity score-matched analysis. J Robot Surg 2021; 16:799-806. [PMID: 34455530 DOI: 10.1007/s11701-021-01301-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Older men undergoing robot-assisted radical prostatectomy (RARP) have been thought to have worse perioperative, functional and oncological outcomes than younger men. However, there is a dearth of matched studies on this subject in the currently available literature. Our study is a matched pair analysis of perioperative, oncological and functional outcomes of RARP in men < 75 years of age versus ≥ 75 years (62 in each group). There was no statistically significant difference in complications, length of stay, pathological stage, positive surgical margins (PSM) and nodal involvement. Older men were less likely to undergo nerve sparing in our study (8.0 vs 75.8% p = 0.01). Potency rates were too low to be compared. The 1-year continence rates, time to continence and the proportion of men with biochemical recurrence (BCR) were similar between the groups. Men ≥ 75 years developed BCR much earlier than < 75 years (30 versus 78 months p = 0.07). However, this was not statistically significant. Age ≥ 75 years was associated with a statistically insignificant 53.5% rise in the risk of BCR. It was also not associated with any increased risk of postoperative complications or PSM. RARP is a safe procedure in senior adults. The oncological and functional outcomes of RARP in senior adults are similar to younger men.
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5
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Lee YJ, Jung JW, Lee S, Lee SW, Kim JH, Hong SK, Byun SS, Lee SE, Jeong SJ. Contemporary trends in radical prostatectomy and predictors of recovery of urinary continence in men aged over 70 years: comparisons between cohorts aged over 70 and less than 70 years. Asian J Androl 2021; 22:280-286. [PMID: 31249271 PMCID: PMC7275794 DOI: 10.4103/aja.aja_62_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We evaluated contemporary trends in radical prostatectomy (RP) in men aged >70 years and investigated associations of selected variables with recovery of urinary continence (UC) in two age groups: >70 and ≤ 70 years. A retrospective cohort of 2301 eligible patients attending our institution from 2004 to 2015 was reviewed. Patients were divided into two groups based on age at surgery (>70 years [n = 610] vs 7 0 years [n = 1691]) and four groups by year of surgery. Over the study period, the proportion of patients aged >70 years gradually increased up to 30.0%, and the rate of robot-assisted RP and neurovascular bundle (NVB) saving increased continually to 80.0% and 67.4% of older patients, respectively. Although the rate of recovery of UC within 12 months (3 months) in patients aged >70 years was lower than that in those aged ≤ 70 years (81.5% [52.6%] vs 88.6% [60.9%], respectively; both P < 0.001), the gap between age groups in the rate of recovery within 12 months narrowed from the second quarter of the study period. Among younger patients, age, robot-assisted RP, prostate volume, membranous urethral length (MUL), and NVB saving were predictors of recovery of UC within 3 or 12 months. In contrast, only age and MUL were predictors of recovery of UC within 3 and 12 months in patients aged >70 years. Therefore, unlike younger patients, only variables (age and MUL), possibly associated with the inherent function of the urinary sphincter, were predictors of recovery of UC in patients aged >70 years.
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Affiliation(s)
- Young Ju Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jin-Woo Jung
- Department of Urology, Catholic Kwandong Univerisity International St. Mary's Hospital, Incheon 22711, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sang Wook Lee
- Department of Urology, Kangwon National University School of Medicine, Chuncheon 24341, Korea
| | - Jeong Hyun Kim
- Department of Urology, Kangwon National University School of Medicine, Chuncheon 24341, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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6
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Dohm A, Diaz R, Nanda RH. The Role of Radiation Therapy in the Older Patient. Curr Oncol Rep 2021; 23:11. [PMID: 33387104 DOI: 10.1007/s11912-020-01000-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Older patients represent a unique subgroup of the cancer patient population for which the role of radiation therapy (RT) requires special consideration. This review will discuss many of these considerations as well as various radiation treatment techniques in the context of a variety of disease sites. RECENT FINDINGS Several recent studies give insight into the management of older cancer patients considering their age, performance status, comorbid conditions, quality of life, genetics, cost, and individual goals. RT plays an evolving and pivotal role in providing optimal care for this population. Recent advances in RT technique allow for more precise treatment delivery and reduced toxicity. Studies evaluating the use of radiation therapy in breast, brain, lung, prostate, rectal, pancreatic, esophageal, and oligometastatic cancer are summarized and discussed in the context of treating the older patient population. Individual age, performance and functional status, comorbid conditions, and patients' objectives and goals should all be considered when presenting treatment options for older patients and age alone should not disqualify patients from curative intent treatments. When possible, hypofractionated courses should be utilized as outcomes are often equivalent and toxicities are reduced. In many cases, RT may be preferable to other treatment options due to decreased toxicity profile and acceptable disease control.
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Affiliation(s)
- Ammoren Dohm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Dr., Tampa, FL, 33612, USA
| | - Roberto Diaz
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Dr., Tampa, FL, 33612, USA
| | - Ronica H Nanda
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Dr., Tampa, FL, 33612, USA.
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Wenzel M, Preisser F, Theissen LH, Humke C, Welte MN, Wittler C, Kluth LA, Karakiewicz PI, Chun FKH, Mandel P, Becker A. The Effect of Adverse Patient Characteristics on Perioperative Outcomes in Open and Robot-Assisted Radical Prostatectomy. Front Surg 2020; 7:584897. [PMID: 33240927 PMCID: PMC7683519 DOI: 10.3389/fsurg.2020.584897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/16/2020] [Indexed: 02/03/2023] Open
Abstract
Objective: To analyze the effect of adverse preoperative patient and tumor characteristics on perioperative outcomes of open (ORP) and robot-assisted radical prostatectomy (RARP). Material and Methods: We retrospectively analyzed 656 patients who underwent ORP or RARP according to intraoperative blood loss (BL), operation time (OR time), neurovascular bundle preservation (NVBP) and positive surgical margins (PSM). Univariable and multivariable logistic regression models were used to identify risk factors for impaired perioperative outcomes. Results: Of all included 619 patients, median age was 66 years. BMI (<25 vs. 25-30 vs. ≥30) had no influence on blood loss. Prostate size >40cc recorded increased BL compared to prostate size ≤ 40cc in patients undergoing ORP (800 vs. 1200 ml, p < 0.001), but not in patients undergoing RARP (300 vs. 300 ml, p = 0.2). Similarly, longer OR time was observed for ORP in prostates >40cc, but not for RARP. Overweight (BMI 25-30) and obese ORP patients (BMI ≥30) showed longer OR time compared to normal weight (BMI <25). Only obese patients, who underwent RARP showed longer OR time compared to normal weight. NVBP was less frequent in obese patients, who underwent ORP, relative to normal weight (25.8% vs. 14.0%, p < 0.01). BMI did not affect NVPB at RARP. No differences in PSM were recorded according to prostate volume or BMI in ORP or RARP. In multivariable analyses, patient characteristics such as prostate volume and BMI was an independent predictor for prolonged OR time. Moreover, tumor characteristics (stage and grade) predicted worse perioperative outcome. Conclusion: Patients with larger prostates and obese patients undergoing ORP are at risk of higher BL, OR time or non-nervesparing procedure. Conversely, in patients undergoing RARP only obesity is associated with increased OR time. Patients with larger prostates or increased BMI might benefit most from RARP compared to ORP.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Lena H Theissen
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Maria N Welte
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
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Aas K, Dorothea Fosså S, Åge Myklebust T, Møller B, Kvåle R, Vlatkovic L, Berge V. Increased curative treatment is associated with decreased prostate cancer-specific and overall mortality in senior adults with high-risk prostate cancer; results from a national registry-based cohort study. Cancer Med 2020; 9:6646-6657. [PMID: 32750229 PMCID: PMC7520350 DOI: 10.1002/cam4.3297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background The association between curative treatment (CurTrt) and mortality in senior adults (≥70 years) with high‐risk prostate cancer (PCa) is poorly documented. In a population‐based cohort we report temporal trends in treatment and PCa‐specific mortality (PCSM), investigating the association between CurTrt and mortality in senior adults with high‐risk PCa, compared to findings in younger men (<70 years). Methods Observational study from the Cancer Registry of Norway. Patients with high‐risk PCa were stratified for three diagnostic periods (2005‐08, 2009‐12 and 2013‐16), age (<70, vs ≥70) and primary treatment (CurTrt: Radical prostatectomy (RP), Radiotherapy (RAD) vs no curative treatment (NoCurTrt)). Competing risk and Kaplan‐Meier methods estimated PCSM and overall mortality (OM), respectively. Multivariable logistic regression models estimated odds for CurTrt, and multivariable Fine Gray and Cox regression models evaluated the hazard ratios for PCSM and OM. Results Of 19 763 evaluable patients, 54% were aged ≥70 years. Senior adults had more unfavorable PCa characteristics than younger men. Across diagnostic periods, use of CurTrt increased from 15% to 51% in men aged ≥70 and 65% to 81% in men aged < 70 years. With median five years follow‐up, PCSM decreased in all patients (P < .05), in the third period restricted to senior adults. In all patients NoCurTrt was associated with three‐fold higher 5‐year PCSM and two‐fold higher OM compared to CurTrt. Conclusions In high‐risk PCa patients, increased use of CurTrt, greatest in senior men, was observed along with decreased PCSM and OM in both senior and younger adults. CurTrt should increasingly be considered in men ≥70 years.
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Affiliation(s)
- Kirsti Aas
- Department of Surgery, Vestre Viken Hospital Trust, Drammen, Norway
| | - Sophie Dorothea Fosså
- Department of Oncology, Oslo University Hospital (OUH), Oslo, Norway.,Cancer Registry of Norway, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Tor Åge Myklebust
- Cancer Registry of Norway, Oslo, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Alesund, Norway
| | | | - Rune Kvåle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway.,Department of Health Registry-based Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Viktor Berge
- University of Oslo, Oslo, Norway.,Department of Urology, OUH, Oslo, Norway
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9
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Merhe A, Hout M, Abou Heidar N, El-Asmar JM, Jaafar R, Mailhac A, Tamim H, Nasr R. Is age an independent risk factor for perioperative mortality and morbidity after radical prostatectomy? Analysis of the American college of surgeons national surgical quality improvement program database. Arab J Urol 2020; 18:72-77. [PMID: 33029410 PMCID: PMC7473160 DOI: 10.1080/2090598x.2020.1721165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives To assess the safety and surgical outcomes of radical prostatectomy (RP) when looking at age as an independent risk factor of perioperative mortality and morbidity. Patients and methods A retrospective cohort study was performed using American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent a RP from 2008 to 2015 were identified. They were divided into three groups based on their age 15 group at the time of surgery. Patients’ characteristics were compared across the three following age groups: 74 years. The correlation between the three different age groups and their respective 30-day postoperative mortality and morbidity were assessed using logistic regression. Unadjusted and adjusted odds ratios (ORs) were estimated. Results A total of 43025 patients were identified, 81.7% were aged 74 years. Overall, 102 patients died in the 30-day postoperative period. Univariate and multivariate analysis showed a significant increase in the 30-day postoperative mortality from 0.1% to 0.4% to 1.3% in the three different age groups 74 years, respectively. In addition, there was a significant increase in postoperative complications in the group of patients aged >74 years. A higher risk of complications 25 related to cardiac (OR 2.18 in age group 70–74 vs OR 7.45 in age group >74 years), respiratory (OR 2.36 vs OR 5.91), neurological (OR 2.28 vs OR 3.44), wound infections (OR 1.49 vs OR 3.25), and sepsis (OR 1.54 vs OR 2.64) were seen with the youngest group taken as a reference. Conclusion Age is an independent risk factor for perioperative mortality and morbidity after RP in elderly patients. Therefore, age should be considered in the decision making of therapeutic options for patients with prostate cancer. Abbreviations BMI: body mass index; CNS: central nervous system; SIOG: International Society of Geriatric Oncology; SEER: Surveillance, Epidemiology, and End Results; ACS: American College of Surgeons; NSQIP: National Surgical Quality Improvement Program; OR: odds ratio
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Affiliation(s)
- Ali Merhe
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Hout
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nassib Abou Heidar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jose M El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola Jaafar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelie Mailhac
- Biostatistics and Clinical Research Unit, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Biostatistics and Clinical Research Unit, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
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Roberts MJ, Papa N, Perera M, Scott S, Teloken PE, Joshi A, Vela I, Pryor D, Martin J, Woo H. A contemporary, nationwide analysis of surgery and radiotherapy treatment for prostate cancer. BJU Int 2019; 124 Suppl 1:31-36. [DOI: 10.1111/bju.14773] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Matthew J. Roberts
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Nepean Urology Research Group; Kingswood NSW Australia
| | - Nathan Papa
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Marlon Perera
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Susan Scott
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
| | - Patrick E. Teloken
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Andre Joshi
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - Ian Vela
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - David Pryor
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | | | - Henry Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
- Department of Uro-Oncology; Chris O'Brien Lifehouse; Sydney NSW Australia
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Abstract
For the estimation of perioperative risks and mortality in the context of radical urological tumor surgery in elderly patients, the guidelines meanwhile require the use of geriatric assessments. The aim of this work is therefore to explain frequently used geriatric assessments and to give an overview of their predictive significance in radical urological tumor surgery. Comprehensive geriatric assessments provide a good description of the patient's state of health, but are hardly feasible in clinical routine due to their complexity. It is more reasonable to use screening tools with subsequent targeted examination of high-risk patients. Special tools allow the standardized assessment of functional status, mobility, cognition, mood, nutrition, frailty, comorbidities and polypharmacy and have different prognostic significance. Evidence on the predictive value of assessments prior to radical urological tumor surgery is mainly described for the systematic classification of comorbidities. In cystectomy, the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) score allow an estimation of the risk of complications and mortality. The focus of assessments prior to prostatectomy is to identify patients with sufficient life expectancy to benefit from radical surgery. CCI and ASA scores as well as the Eastern Co-operative Oncology Group (ECOG) score can help to assess the risk of perioperative complications in kidney tumor surgery.
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Affiliation(s)
- A Kahlmeyer
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - P J Goebell
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - B Wullich
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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