Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy.

Autor: Froehner M; Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany. Michael.Froehner@uniklinikum-dresden.de., Koch R; Department of Medical Statistics and Biometry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany., Hübler M; Department of Anesthesiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany., Heberling U; Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany., Novotny V; Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany., Zastrow S; Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany., Hakenberg OW; Department of Urology, University of Rostock, Ernst-Heydemann-Strasse 6, D-18055, Rostock, Germany., Wirth MP; Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany.
Jazyk: angličtina
Zdroj: BMC urology [BMC Urol] 2018 Oct 22; Vol. 18 (1), pp. 91. Date of Electronic Publication: 2018 Oct 22.
DOI: 10.1186/s12894-018-0402-z
Abstrakt: Background: Radical cystectomy bears a considerable perioperative mortality risk particularly in elderly patients. In this study, we searched for predictors of perioperative and long-term competing (non-bladder cancer) mortality in elderly patients selected for radical cystectomy.
Methods: We stratified 1184 consecutive patients who underwent radical cystectomy for high risk superficial or muscle-invasive urothelial or undifferentiated carcinoma of bladder into two groups (age < 80 years versus 80 years or older). Multivariable and cox proportional hazards models were used for data analysis.
Results: Whereas Charlson score and the American Society of Anesthesiologists (ASA) physical status classification (but not age) were independent predictors of 90-day mortality in younger patients, only age predicted 90-day mortality in patients aged 80 years or older (odds ratio per year 1.24, p = 0.0422). Unlike in their younger counterparts, neither age nor Charlson score or ASA classification were predictors of long-term competing mortality in patients aged 80 years or older (hazard ratios 1.07-1.10, p values 0.21-0.77).
Conclusions: This data suggest that extrapolations of perioperative mortality or long-term mortality risks of younger patients to octogenarians selected for radical cystectomy should be used with caution. Concerning 90-day mortality, chronological age provided prognostic information whereas comorbidity did not.
Databáze: MEDLINE
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