Comparative Performance of Comorbidity Indices for Estimating Perioperative and 5-Year All Cause Mortality Following Radical Cystectomy for Bladder Cancer
Comparative Performance of Comorbidity Indices for Estimating Perioperative and 5-Year All Cause Mortality Following Radical Cystectomy for Bladder Cancer
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DOI：
10.1016/j.juro.2013.01.010
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发表时间：
2013-07-01
影响因子：
6.6
通讯作者：
Frank, Igor
中科院分区：
文献类型：
--
作者：
Boorjian, Stephen A.;Kim, Simon P.;Frank, Igor
用途：根治性膀胱切除术仍与不可忽略的围手术期死亡风险相关，术后数年内全因死亡率仍相对较高。我们调查了各种并发症指数预测根治性cyberfollows.Materials和方法后围手术期和5年全因死亡率的比较能力：我们评估了891例根治性cyberfollows1994年至2005年。采用考克斯回归模型评估美国麻醉医师协会（阿萨）评分、Charlson合并症指数、Elixhauser指数和ECOG（东部肿瘤协作组）体力状态与结局的关系。模型的性能进行了比较，受试者工作曲线下面积。结果：共有33例（3.7%）患者在根治性化疗90天内死亡。在多变量分析中，局部晚期病理肿瘤分期（HR 4.86，p = 0.002）以及Elixhauser指数（HR 1.48，p = 0.002）、阿萨评分（HR 3.17，p = 0.001）和ECOG（HR 2.40，p < 0.0001）与90天围手术期死亡率显著相关。根治性膀胱切除术后的中位随访时间为10.1年，在此期间有576例患者死亡。Charlson合并症指数（HR 1.23，p < 0.0001）、Elixhauser指数（HR 1.28，p < 0.0001）、阿萨评分（HR 1.44，p = 0.007）和ECOG（HR 1.97，p < 0.0001）是5年全因死亡率的独立预测因素。此外，Charlson共患病指数（AUC 0.798，p < 0.0001），Elixhauser指数（AUC 0.770，p = 0.03）和ECOG（AUC 0.769，p = 0.03）显著增强了不包括合并症状态的基础模型的性能（AUC 0.757）预测5年全因死亡率。合并症状态可预测根治性膀胱切除术后围手术期死亡和5年全因死亡率，因此，应纳入患者咨询和风险分层模型。进一步的前瞻性研究是必要的，以克服回顾性的限制，在确定各种合并症指数的相对预后价值。
Purpose: Radical cystectomy continues to be associated with a nonnegligible risk of perioperative death and all cause mortality in the years after surgery remains relatively high. We investigated the comparative ability of various comorbidity indices to predict perioperative and 5-year all cause mortality after radical cystectomy.Materials and Methods: We evaluated 891 patients who underwent radical cystectomy between 1994 and 2005. The associations of American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, Elixhauser index and ECOG (Eastern Cooperative Oncology Group) performance status with outcomes were assessed using Cox regression models. Model performance was compared with area under receiver operating curves.Results: A total of 33 (3.7%) patients died within 90 days of radical cystectomy. On multivariate analysis locally advanced pathological tumor stage (HR 4.86, p = 0.002) as well as Elixhauser index (HR 1.48, p = 0.002), ASA score (HR 3.17, p = 0.001) and ECOG (HR 2.40, p < 0.0001) were significantly associated with 90-day perioperative mortality. Median followup after radical cystectomy was 10.1 years, during which time 576 patients died. Charlson comorbidity index (HR 1.23, p < 0.0001), Elixhauser index (HR 1.28, p < 0.0001), ASA score (HR 1.44, p = 0.007) and ECOG (HR 1.97, p < 0.0001) were independent predictors of 5-year all cause mortality. Moreover Charlson comorbidity index (AUC 0.798, p < 0.0001), Elixhauser index (AUC 0.770, p = 0.03) and ECOG (AUC 0.769, p = 0.03) significantly enhanced the performance of a base model which did not include comorbidity status (AUC 0.757) to predict 5-year all cause mortality.Conclusions: Comorbidity status is predictive of perioperative death and 5-year all cause mortality after radical cystectomy and, therefore, should be incorporated into patient counseling and risk stratification models. Further prospective studies are warranted to overcome the retrospective limitations in determining the relative prognostic value of various comorbidity indices.