Survival analysis in men undergoing radical prostatectomy at an age of 70 years or older

Abstract

Objectives To compare comorbidity measures and to analyze survival rates in men undergoing radical prostatectomy at age 70 years or older. Materials and methods A total of 329 consecutive patients aged 70 or more years who underwent radical prostatectomy between 1992 and 2004 were studied. The patients were stratified by 5 comorbidity classifications, tumor stage, Gleason score, and PSA value. Mortality was subdivided into overall, comorbid, competing, prostate cancer-specific, and second cancer-specific mortality. Competing risk and Kaplan-Meier survival curves as well as Mantel-Haenszel hazard ratios were calculated. Comparisons were made with the log-rank test. Cox proportional hazard models were used to determine the independent significance of prognostic variables. Results Considering the dose-response relationship, P values and the discrimination of 2 risk groups, the Charlson score was the best of the tested comorbidity classifications in men selected for radical prostatectomy at age 70 years or older. Beside the tumor-related factors Gleason score 8–10 (hazard ratio 2.61, P = 0.0234) and lymph node involvement (hazard ratio 2.89, P = 0.0145), a Charlson score of 1 or greater was identified as an independent predictor of overall mortality (hazard ratio 2.16, P = 0.0441). Without comorbidity or adverse tumor-related risk factors, elderly men had an excellent 10-year overall survival probability (77% to 100%, depending on the classification used), whereas 10-year overall survival was distinctly poor in the presence of lymph node metastases (30%) or Gleason score 8–10 disease (33%). Conclusions The Charlson comorbidity score may be used to stratify men selected for radical prostatectomy at age 70 years or older and to estimate long-term survival probability. In the absence of adverse tumor-related parameters or serious comorbidity, long-term survival probability is excellent in this subgroup.