Faculty Collaboration Database

Older patients with low Charlson score and high-risk prostate cancer benefit from radical prostatectomy. World J Urol 2016 Oct;34(10):1367-72

Date

02/22/2016

Pubmed ID

26897499

DOI

10.1007/s00345-016-1784-8

Scopus ID

2-s2.0-84958744104 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

INTRODUCTION: The aim of the study was to identify the appropriate level of Charlson comorbidity index (CCI) in older patients (>70 years) with high-risk prostate cancer (PCa) to achieve survival benefit following radical prostatectomy (RP).

METHODS: We retrospectively analyzed 1008 older patients (>70 years) who underwent RP with pelvic lymph node dissection for high-risk prostate cancer (preoperative prostate-specific antigen >20 ng/mL or clinical stage ≥T2c or Gleason ≥8) from 14 tertiary institutions between 1988 and 2014. The study population was further grouped into CCI < 2 and ≥2 for analysis. Survival rate for each group was estimated with Kaplan-Meier method and competitive risk Fine-Gray regression to estimate the best explanatory multivariable model. Area under the curve (AUC) and Akaike information criterion were used to identify ideal 'Cut off' for CCI.

RESULTS: The clinical and cancer characteristics were similar between the two groups. Comparison of the survival analysis using the Kaplan-Meier curve between two groups for non-cancer death and survival estimations for 5 and 10 years shows significant worst outcomes for patients with CCI ≥ 2. In multivariate model to decide the appropriate CCI cut-off point, we found CCI 2 has better AUC and p value in log rank test.

CONCLUSION: Older patients with fewer comorbidities harboring high-risk PCa appears to benefit from RP. Sicker patients are more likely to die due to non-prostate cancer-related causes and are less likely to benefit from RP.

Author List

Sivaraman A, Ordaz Jurado G, Cathelineau X, Barret E, Dell'Oglio P, Joniau S, Bianchi M, Briganti A, Spahn M, Bastian P, Chun J, Chlosta P, Gontero P, Graefen M, Jeffrey Karnes R, Marchioro G, Tombal B, Tosco L, van der Poel HH, Sanchez-Salas R

Author

Arjun Sivaraman MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Biopsy
Follow-Up Studies
France
Humans
Male
Neoplasm Grading
Prostate
Prostatectomy
Prostatic Neoplasms
Retrospective Studies
Risk Assessment
Risk Factors
Survival Rate
Time Factors