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935 Charlson score predicts overall survival and cancer related death in elderly patients featuring high risk prostate cancer
Title
935
Charlson score predicts overall survival and cancer related death in elderly patients featuring high risk prostate cancer Eur Urol Suppl 2015;14/2;e935
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Ordaz Jurado G.1 , Sánchez Salas R.1 , Sivaraman A. 1 , Joniau S. 2 , Bianchi M. 3 , Spahn M. 4 , Bastian P. 5 , Chun J. 6 , Chlosta P. 7 , Gontero P. 8 , Graefen M. 6 , Karnes R.J. 9 , Marchioro G.10 , Tombal B. 11 , Tosco L. 12 , Van Der Poel H.13 , Cathelineau X. 14 , European Multicenter Prostate Cancer Clinical and Translational research group (EMPaCT), Lier, Belgium 1 L'institut
Mutualiste Montsouris, Dept. of Urology, Paris, France, 2 EMPaCT, Dept. of Urology, Lier, Belgium, 3 EMPaCT, Dept. of Urology,
Milan, Italy, 4 EMPaCT, Dept. of Urology, Berne, Switzerland, 5 EMPaCT, Dept. of Urology, Munich, Germany, 6 EMPaCT, Dept. of Urology, Hamburg, Germany, 7 EMPaCT, Dept. of Urology, Krakow, Poland, 8 EMPaCT, Dept. of Urology, Turin, Italy, 9 EMPaCT, Dept. of Urology, Rochester, United States of America, 10 EMPaCT, Dept. of Urology, Novara, Italy, 11 EMPaCT, Dept. of Urology, Brussels, Belgium, 12 EMPaCT,
Dept. of Urology, Leuven, Belgium, 13 EMPaCT, Dept. of Urology, Amsterdam, The Netherlands, 14 L'Institut Mutualiste
Montsouris, Dept. of Urology, Paris, France INTRODUCTION & OBJECTIVES: Post-radical prostatectomy (RP) adverse features predicting cancer-related death (CRD) include tumours invading the seminal vesicles (pT3b) or neighboring organs (pT4), lymph node invasion (LNI), number of lymphnode removed (NLR), positive surgical margins (PSM) and high Gleason scores (GS 8-10). Patients having at least one of these adverse factors are often counseled for adjuvant treatment depending on overall survival (OS). However in elderly patients, scores as ASA or Charlson scores among other features, might allow clinicians to limit the use of aggressive adjuvant treatment strategies or even primary surgical treatment to those who might not achieve benefit during their lifetime avoiding related side effects. MATERIAL & METHODS: We retrospectively analyzed a 7650 case multicenter high-risk prostate cancer (Pca) radical prostatectomy database selecting patients with >= 70 years old. Covariates considered in the models analyzing predictors for death from all causes (DAC) and CRD included Age, ASA score, Charlson score (CS), T pathological stage (T-PS), preoperative PSA, Linphadenectomy (extended) performed or not, number of nodes removed, lymphnode invasion (LNI), positive surgical margins (PSM), Gleason score (GS), relapsing disease (RD), body mass index (BMI) and adjuvant RT/ADT/RT+ADT. Descriptive and multivariable analysis were performed. The first one was performed to identify independent predictors of DAC. The second for independent predictors for CRD. Both based on binary listwise logistic regression, with Akaike information criterion (AIC), area under the curve (AUC), sensibility (SE) and specificity (SP) outcomes as fit model diagnosis. All analyses have been performed using STATA® software, version 13.1 for Mac. RESULTS: A total of 2106 patients from 14 high-volume centers were included in the analysis. Mean age was 72.8 years (SD 2.46). 206 (9.78%) patients were classified as ASA 3-4 and 497 (23.6%) as CS >=1. Mean PSA was 21.7 ng/ml (SD 50.5). At final histopathology, 800 (38%) had pT3b-T4 disease, GS was 8-10 in 589 (28%), LNI was found in 518 (24.6%) and 822 (39%) PSM. Adjuvant RT, ADT and RT+ADT were administered in 359 (17%), 391 (18.6%) and 437 (20.7%), respectively. Mean follow up was 5.18 years (DS 4.47). BCR occur in 649 (30.8%) and CF in 150 (7.1%) of which distant in 59 (2.8%). Total deaths accounted 341 (16.2%) and CRD for 100 (4.7%) cases.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/935.html[19/02/2015 08:23:44]
Title Variable
Odds ratio 95% confidence interval
Gleason score
1.69
(1.17 , 2.43)
Charlson score (>1) 0.94
(0.51 , 1.58)
T3b-T4
(1.86 , 13.02)
4.92
Table1: First multivariate analysis predicting CRD within 10-years from RP in aged men. AIC= 128.6 AUC= 0.926 SE= 82.9% SP=94.0% p value <0.001
Variable
Odds ratio 95% Confidence interval
Gleason score
1.28
(1.01 , 1.63)
Charlson score (>1)
1.61
(1.09 , 2,36)
Number of lymphnodes removed 0.95
(0.93 , 0.98)
Table2: Second multivariate analysis predicting DAC within 10-years from RP in aged men. AIC=62.5 AUC=0.889 SE=69.2% SP=99.4% p value <0,001. CONCLUSIONS: Multicenter data confirms that elderly patients survival harboring high risk prostate cancer will benefit from radical treatment if they are Charlson score 1 or less.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/935.html[19/02/2015 08:23:44]
935
Charlson score predicts overall survival and cancer related death in elderly patients featuring high risk prostate cancer Eur Urol Suppl 2015;14/2;e935
Print! Print!
Ordaz Jurado G.1 , Sánchez Salas R.1 , Sivaraman A. 1 , Joniau S. 2 , Bianchi M. 3 , Spahn M. 4 , Bastian P. 5 , Chun J. 6 , Chlosta P. 7 , Gontero P. 8 , Graefen M. 6 , Karnes R.J. 9 , Marchioro G.10 , Tombal B. 11 , Tosco L. 12 , Van Der Poel H.13 , Cathelineau X. 14 , European Multicenter Prostate Cancer Clinical and Translational research group (EMPaCT), Lier, Belgium 1 L'institut
Mutualiste Montsouris, Dept. of Urology, Paris, France, 2 EMPaCT, Dept. of Urology, Lier, Belgium, 3 EMPaCT, Dept. of Urology,
Milan, Italy, 4 EMPaCT, Dept. of Urology, Berne, Switzerland, 5 EMPaCT, Dept. of Urology, Munich, Germany, 6 EMPaCT, Dept. of Urology, Hamburg, Germany, 7 EMPaCT, Dept. of Urology, Krakow, Poland, 8 EMPaCT, Dept. of Urology, Turin, Italy, 9 EMPaCT, Dept. of Urology, Rochester, United States of America, 10 EMPaCT, Dept. of Urology, Novara, Italy, 11 EMPaCT, Dept. of Urology, Brussels, Belgium, 12 EMPaCT,
Dept. of Urology, Leuven, Belgium, 13 EMPaCT, Dept. of Urology, Amsterdam, The Netherlands, 14 L'Institut Mutualiste
Montsouris, Dept. of Urology, Paris, France INTRODUCTION & OBJECTIVES: Post-radical prostatectomy (RP) adverse features predicting cancer-related death (CRD) include tumours invading the seminal vesicles (pT3b) or neighboring organs (pT4), lymph node invasion (LNI), number of lymphnode removed (NLR), positive surgical margins (PSM) and high Gleason scores (GS 8-10). Patients having at least one of these adverse factors are often counseled for adjuvant treatment depending on overall survival (OS). However in elderly patients, scores as ASA or Charlson scores among other features, might allow clinicians to limit the use of aggressive adjuvant treatment strategies or even primary surgical treatment to those who might not achieve benefit during their lifetime avoiding related side effects. MATERIAL & METHODS: We retrospectively analyzed a 7650 case multicenter high-risk prostate cancer (Pca) radical prostatectomy database selecting patients with >= 70 years old. Covariates considered in the models analyzing predictors for death from all causes (DAC) and CRD included Age, ASA score, Charlson score (CS), T pathological stage (T-PS), preoperative PSA, Linphadenectomy (extended) performed or not, number of nodes removed, lymphnode invasion (LNI), positive surgical margins (PSM), Gleason score (GS), relapsing disease (RD), body mass index (BMI) and adjuvant RT/ADT/RT+ADT. Descriptive and multivariable analysis were performed. The first one was performed to identify independent predictors of DAC. The second for independent predictors for CRD. Both based on binary listwise logistic regression, with Akaike information criterion (AIC), area under the curve (AUC), sensibility (SE) and specificity (SP) outcomes as fit model diagnosis. All analyses have been performed using STATA® software, version 13.1 for Mac. RESULTS: A total of 2106 patients from 14 high-volume centers were included in the analysis. Mean age was 72.8 years (SD 2.46). 206 (9.78%) patients were classified as ASA 3-4 and 497 (23.6%) as CS >=1. Mean PSA was 21.7 ng/ml (SD 50.5). At final histopathology, 800 (38%) had pT3b-T4 disease, GS was 8-10 in 589 (28%), LNI was found in 518 (24.6%) and 822 (39%) PSM. Adjuvant RT, ADT and RT+ADT were administered in 359 (17%), 391 (18.6%) and 437 (20.7%), respectively. Mean follow up was 5.18 years (DS 4.47). BCR occur in 649 (30.8%) and CF in 150 (7.1%) of which distant in 59 (2.8%). Total deaths accounted 341 (16.2%) and CRD for 100 (4.7%) cases.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/935.html[19/02/2015 08:23:44]
Title Variable
Odds ratio 95% confidence interval
Gleason score
1.69
(1.17 , 2.43)
Charlson score (>1) 0.94
(0.51 , 1.58)
T3b-T4
(1.86 , 13.02)
4.92
Table1: First multivariate analysis predicting CRD within 10-years from RP in aged men. AIC= 128.6 AUC= 0.926 SE= 82.9% SP=94.0% p value <0.001
Variable
Odds ratio 95% Confidence interval
Gleason score
1.28
(1.01 , 1.63)
Charlson score (>1)
1.61
(1.09 , 2,36)
Number of lymphnodes removed 0.95
(0.93 , 0.98)
Table2: Second multivariate analysis predicting DAC within 10-years from RP in aged men. AIC=62.5 AUC=0.889 SE=69.2% SP=99.4% p value <0,001. CONCLUSIONS: Multicenter data confirms that elderly patients survival harboring high risk prostate cancer will benefit from radical treatment if they are Charlson score 1 or less.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/935.html[19/02/2015 08:23:44]