Mortalidad y complicaciones tras PTR: edad y comorbilidades
19
Journal of the National Cancer Institute, Vol. 97, No. 20, October 19, 2005
ARTICLES 1527
index). Because of sample size restrictions, tests for interaction
were not performed for mortality models.
P
values of .05 were
considered statistically significant. All analyses were performed
using SAS version 8.12 (SAS Corporation, Cary, NC), and all
statistical tests were two-sided.
Among the total cohort, 2246 men (20.4%) had at least one
complication within 30 days of radical prostatectomy. Complica-
tion rates by category for all 11010 men are shown in Table 1. In
univariate analyses, increasing age was associated with increased
risks of cardiac (
P
trend
<.001), respiratory (
P
trend
= .048), vascular
Table1.
Complication and mortality outcomes (number and percentage) within 30 days among men who underwent radical prostatectomy by age group
All patients
<60 y of age
60 to 69 y of age
70 to 79 y of age
(N = 11 010)
(N = 3199)
(N = 6587)
(N = 1217)
Outcome
Mortality
53 (0.48%)
6 (0.19%)
38 (0.58%)
8 (0.66%)
Complication
Any
2246 (20.40%)
560 (17.51%)
1356 (20.59%)
327 (26.87%)
Cardiac
309 (2.81%)
52 (1.63%)
187 (2.84%)
69 (5.67%)
Respiratory
293 (2.66%)
76 (2.38%)
169 (2.57%)
47 (3.86%)
Vascular
215 (1.95%)
41 (1.28%)
148 (2.25%)
26 (2.14%)
Wound
555 (5.04%)
138 (4.31%)
342 (5.19%)
73 (6.00%)
Genitourinary
829 (7.53%)
214 (6.69%)
502 (7.62%)
111 (9.12%)
Miscellaneous medical
427 (3.88%)
112 (3.50%)
255 (3.87%)
59 (4.85%)
Miscellaneous surgical
576 (5.23%)
154 (4.81%)
351 (5.33%)
71 (5.83%)
16
ARTICLE ARTICLES
30-Day Mortality and Major Complications after Radical
Prostatectomy: Influence of Age and Comorbidity
Shabbir M. H. Alibhai, Marc Leach, George Tomlinson, Murray D. Krahn,
Neil Fleshner, Eric Holowaty, Gary Naglie
Background:
Radical prostatectomy isassociated with excel-
lent long-term disease control for localized prostate cancer.
Prior studieshave suggested an increased risk of short-term
complicationsamongolder menwhounderwent radical pros-
tatectomy, but these studies did not adjust for comorbidity.
Methods:
We examined mortality and complications occur-
ring within 30 days following radical prostatectomy among
all 11010 men who underwent this surgery in Ontario,
Canada, between 1990 and 1999 usingmultivariable logistic
regression modeling. We adjusted for comorbidity using two
commoncomorbidity indices. Statistical testsweretwo-sided.
Results:
Overall, 53 men (0.5%) died, and 2246 (20.4%) had
one or more complicationswithin 30 daysof radical prosta-
cians may believe that older men with prostate cancer are less
likely to live as long as younger men and, therefore, are less
likely to benefit from aggressive treatment
(6)
. Second, radical
prostatectomy is associated with substantial potential morbidity
and mortality, and many clinicians consider older men to be at
higher risk of surgery-associated short- and long-term complica-
tions
(7)
. Major long-term complications associated with radical
prostatectomy include urinary and sexual dysfunction
(8)
. Short-
term, perioperative morbidities include cardiovascular complica-
tions (e.g., myocardial infarction, congestive heart failure, and
arrhythmias), venous thromboembolism, rectal injury, and wound
infection
(9)
. Several studies have demonstrated higher radical
prostatectomy complication rates with increasing age
(9,10)
.
Begg et al. studied complication rates among 11522 men who
Downloa
Journal of the N tional Cancer Institute, Vol. 97, No. 20, October 19, 2005
ARTICLES 1525
CI = 0.2 to 1.1%) for men aged 70–79 years. In adjust d
m dels, agewasassoci ted with an increased risk of cardiac
(
P
trend
<.001), respiratory (
P
trend
= .01), and miscellaneous
medical (
P
trend
= .058) complications. Similarly, increasing
comorbidity wasassociated with a higher risk of all catego-
riesof complications.
Conclusions:
Increasingcomorbidity is
a stronger predictor thanageof almost all categoriesof early
complicationsafter radical prostatectomy. The risk of post-
operative mortality after radical prostatectomy is relatively
low for otherwise healthy older men up to age 79. [J Natl
Can er Inst 2005;97:1525–32]
Prostate cancer is the most commonly diagnosed cancer in
men and the third most common cause of cancer death in men
(1)
.
Most patients have localized disease at the time of diagnosis
that is potentially curable with radical prostatectomy or radiation
therapy. In comparison with conservative management, where the
cancer is followed without local therapy (i.e., surgery or radiation),
radical prostatectomy is associated with lower disease-specific
mortality, lower rates of local progression and development of
metastases, and higher overall survival
(2)
.
Despite the impressive long-term outcomes with radical pros-
tatectomy, less than 5% of men over age 70 with prostate cancer
receive this treatment modality in Canada
(3)
. In one American
study of men with clinically localized disease, those under age 60
years were 25 times more likely to receive radical prostatectomy
than those aged 70 years or older
(4)
. In a recent survey, 69%
of Canadian urologists and 53% of American urologists agreed
with the state ent that ag 70 sh uld be the upper age limit for
radical prostatectomy
(5)
.
Two possible explanations for these differences in the rate of
radical prostatectomy by age have been proposed. First, clini-
tory (11%), vascular (4.7%), wound-related or bleeding (2.6%),
genitourinary (2.8%), miscellaneous medical (7.6%), nd mis-
c llaneous surgical (6.6%) complicati ns
(10)
.
Published st dies on complication following radical prosta-
tectomy are limited by a l ck of information on the interac ion
among age, comorbid conditions, and complication rates. How-
ever, increasing comorbidity has been shown to increase the risk
of a variety of adverse postoperative outcomes of a variety of
surgical procedures
(11,12)
. Indeed, in one of the few studies ex-
amining the impact of comorbidity on short-term complications,
Begg et al.
(10)
demonstrated increasing 30-day mortality and
postoperative complication rates with increasing comorbidity.
However, the interaction between age and comorbidity was not
examined.
As patients age, chronic comorbid illnesses become more
common
(13)
. However, association between age and comor-
bidity is imperfect, and many older adults have few or no
comorbid conditions. Knowing the independent contribution
of age and comorbidity to major short-term complications of
radical prostatectomy is important for at least two reasons.
Affiliations of authors:
Division of General Internal Medicine and Clinical
Epidemiology, University Health Network, Toronto, Canada (SMHA, ML, GT,
MDK, GN); Geriatric Program, Toronto Rehabilitation Institute, Canada (SMHA,
GN); Departments of Medicine (SMHA, MDK, GN), Health Policy, Management
and Evaluation (SMHA, MDK, GN), Public Health Sciences (GT), and Surgery
(NF), University of Toronto, Canada; Division of Preventive Oncology, Cancer
Care Ontario, Toronto, Canada (EH).
Correspondence to:
Shabbir M. H. Alibhai, MD, MSc, University Health
Network, Room EN 14-214, 200 Elizabeth Street, Toronto. M5G 2C4, Canada
(e-mail:
.
See
“Notes” following “References.”
DOI: 10.1093/jnci/dji313
© The Author 2005. Published by Oxford University Press. All rights reserved.
For Permissions, please e-mail:
by guest on September 7, 2016
/jnci.oxfordjournals.org/
mortalit
prostatec
comorbi
cantly as
miscella
miscella
prostatec
with incr
complic
Sever
mortalit
general,
mortalit
included
creasing
the other
and age
between
increase
Our s
tionship
prostatec
in como
Table 2.
Associations between comorbid conditions and 30-day mortality
after radical prostatectomy in men undergoing this surgery in Ontario, Canada,
between 1990 and 1999*
Univa iate
Final multivariable model†
Variable
OR (95% CI)
OR (95% CI)
Age (per decade)
2.52 (1.52 to 4.19)
2.04 (1.22 to 3.39)
Charlson scor
1.44 (1.00 to 2.06)
0.91 (0.54 to 1.53)
iagnosis count
1.16 (1.05 to 1.29)
1.04 (0.89 to 1.22)
Later y of surgery‡
0.58 (0.34 to 0.99)
0.58 (0.33 to 1.01)
Anemia
0.78 (0.11 to 5.68)
–
Cancer
1.53 (0.48 to 4.92)
–
Cardiovascula disease
4.50 (1.88 to 10.80)
2.43 (1.12 to 5.26)
2 to 3.69)
–
Diabetes
1.58 (0.57 to 4.38)
–
Hypertension
1.91 (1.00 to 3.64)
1.17 (0.55 to 2.50)
Obesity
2.68 (0.37 to 19.65)
–
Peptic ulcer disease
5.38 (0.73 to 39.92)
–
Stroke
13.82 (3.22 to 59.29)
7.84 (1.84 to 39.77)
*OR = odds ratio; CI = confidence interval; COPD = chronic obstructive
pulmonary disease.
†The following comorbid conditions were found in too few patients to permit
meaningful multivariable analyses: AIDS, connective tissue disease, dementia,
hypercholesterolemia, liver disease, peripheral vascular disease, and renal failure.
The final model included all variables listed in one regression model.
‡Year of surgery was dichotomized into 1995–1999 vs. 1990–1994.
