The impact of co-morbid disease on cancer control and survival following radical cystectomy
The impact of co-morbid disease on cancer control and survival following radical cystectomy
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DOI：
10.1016/s0022-5347(05)64046-3
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发表时间：
2003-01-01
影响因子：
6.6
通讯作者：
Wei, JT
中科院分区：
文献类型：
--
作者：
Miller, DC;Taub, DA;Wei, JT
目的：我们澄清的影响，同时医疗疾病对肿瘤的控制和生存根治cycloplastic.Materials和方法：共106例连续的临床本地化（cT2或更低）的疾病进行根治性cycloplasticin在密歇根大学1997年和1998年之间。Charlson指数是一种经验证的风险调整指数，用于评估术前合并症。3个主要终点为病理分期、疾病特异性生存期和总生存期。Logistic回归模型被用来确定Charlson指数和病理分期之间的关系，而考克斯回归模型被用于2生存endpoint.Results：我们的研究人群24%的Charlson指数评分为2或更高。心肌梗死、非尿路上皮实体恶性肿瘤和脑血管疾病是最常见的合并症，分别为14%、12%和10%。在双变量分析中，Charlson指数与疾病特异性（p = 0.049）和总体（p = 0.016）生存率降低显著相关。在多变量模型中，该指数与癌症特异性生存率降低（p = 0.049）和膀胱外疾病风险增加（p 0.033）独立相关。结论：我们证明了共病与根治性膀胱切除术后不良病理和生存结局之间的相关性。这一发现强调了在推荐和进行手术之前评估整体健康状况的价值。此外，我们的研究结果强调，在比较根治性膀胱切除术后的结局时，需要调整合并症。
Purpose: We clarified the impact of concurrent medical disease on tumor control and survival following radical cystectomy.Materials and Methods: A total of 106 consecutive patients with clinically localized (cT2 or less) disease underwent radical cystectomy at the University of Michigan between 1997 and 1998. The Charlson Index, a validated risk adjustment index, was used to assess preoperative co-morbidity. The 3 primary end points were pathological stage, disease specific survival and overall survival. Logistic regression models were used to determine the relationship between Charlson Index and pathological stage, while Cox regression models were used for the 2 survival end points.Results: Of our study population 24% had a Charlson Index score of 2 or greater. Myocardial infarction, nonurothelial solid malignancies and cerebrovascular disease were the most common co-morbid conditions at 14%, 12% and 10%, respectively. On bivariate analysis the Charlson Index was significantly associated with decreased disease specific (p = 0.049) and overall (p = 0.016) survival. In a multivariate model the index was independently associated with decreased cancer specific survival (p = 0.049) and increased risk of extravesical disease (p 0.033).Conclusions: We demonstrated an association between co-morbid illness and adverse pathological and survival outcome following radical cystectomy. This finding underscores the value of assessing overall health before recommending and proceeding with surgery. Moreover, our results emphasize the need to adjust for co-morbidity when comparing outcomes following radical cystectomy.