Age and Comorbidity impact surgical therapy in older bladder carcinoma patients - A population-based study
Age and Comorbidity impact surgical therapy in older bladder carcinoma patients - A population-based study
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DOI：
10.1002/cncr.21354
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发表时间：
2005-10-15
期刊：
影响因子：
6.2
通讯作者：
Edwards, BK
中科院分区：
文献类型：
--
作者：
Prout, GR;Wesley, MN;Edwards, BK
背景资料。膀胱癌通常发生在老年患者中，他们也可能有其他可能影响手术治疗的合并症。本研究旨在描述膀胱癌患者合并疾病的分布情况，并根据美国麻醉学家协会的身体状况分类确定这些情况是否会影响手术治疗的选择。方法：作者研究了1992年来自国家癌症研究所监测、流行病学和最终结果项目的6个基于人群的癌症登记。总共发现了820名年龄在55岁及以上的人。随机抽取一组新诊断的膀胱癌患者，根据登记、年龄组(年龄55-，65-74岁，75岁及以上)和性别进行分层。关于合并症的数据从医疗记录中提取出来，并与常规收集的癌症登记数据合并。主要结果是并存疾病的患病率和分布，美国麻醉学家协会的身体状况分类，以及肌肉侵犯患者接受膀胱切除术的情况。结果：高血压、慢性肺部疾病、关节炎和心脏病至少影响研究人群的15%。大约38%的患者是现在或以前吸烟者。超过90%的浅表疾病患者仅行经尿道电切术。在那些有肌肉侵犯的患者中，55-59岁的患者中只有55%的人接受了膀胱切除术；在85岁及以上的患者中，这一比例下降到4%。在美国麻醉学家协会身体状况分级为0-2的患者中，膀胱切除率在55-59岁的患者中为53%，在85岁及以上的患者中为9%。结论：浅表疾病患者的年龄没有明显的治疗差异。在有肌肉侵犯的患者中，75岁及以上患者根治性膀胱切除术的可能性(14%)低于55-年龄组(48%)和65-74岁组(43%)。患者的年龄可能有助于肌肉侵袭性疾病患者的治疗决定，即使考虑到共病。
BACKGROUND. Bladder carcinoma often occurs in older patients who also may have other comorbid conditions that could influence the administration of surgical therapy. The current study was conducted to describe the distribution of comorbid conditions in patients with bladder carcinoma and ascertain whether these con- ditions, as grouped by the American Society of Anesthesiologists physical status classification, affected the choice of surgical therapy.METHODS. The authors examined six population-based cancer registries from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program in 1992. A total of 820 individuals age 55 years and older was found. A random sample of newly diagnosed bladder carcinoma patients were stratified according to registry, age group (ages 55-64 yrs, ages 65-74 yrs, and age 75 yrs and older), and gender. Data regarding comorbid conditions were abstracted from the medical records and merged with routinely collected cancer registry data. The main out- come measures were the prevalence and distribution of comorbid conditions, American Society of Anesthesiologists physical status classification, and the receipt of cystectomy in patients with muscle invasion.RESULTS. Hypertension, chronic pulmonary disease, arthritis, and heart disease were found to affect at least 15% of the study population. Approximately 38% of patients were current or former smokers. Greater than 90% of patients with superficial disease were treated with transurethral resection alone. Among those patients with muscle invasion, only 55% of those ages 55-59 years underwent cystectomy; this percentage dropped to 4% in patients age 85 years and older. Among patients with an American Society of Anesthesiologists physical status classification of 0-2, the cystectomy rate ranged from 53% in those ages 55-59 years to 9% in those age 85 years and older.CONCLUSIONS. There were no significant treatment differences noted with regard to age among patients with superficial disease. Among those patients with muscle invasion, those age 75 years and older were less likely to undergo radical cysteclance, tomy (14%) compared with patients ages 55-64 years (48%) and those ages 65-74 years (43%). Patient age may contribute to treatment decisions in patients with muscle-invasive disease, even when comorbidity is taken into account.