查尔森合并症指数对前列腺癌根治术后患者预后的评估价值

Prognosis predictive value of Charlson comorbidity index in prostate cancer patients after radical prostatectomy

关键词:  查尔森合并症指数  前列腺癌根治术  预后  生存期

Key words:  Charlson comorbidity index  radical prostatectomy  prognosis  survival

摘要:

目的　探讨查尔森合并症指数（CCI）评估前列腺癌根治术(RP）后患者预后的价值。方法　回顾性分析2008年1月至2013年1月于苏北医院接受RP手术患者的临床资料。采集年龄、身体质量指数（BMI）、既往基础疾病及预后、治疗前前列腺特异性抗原（PSA），临床分期、穿刺病理分级、手术时间、手术出血量、术后病理切缘阳性及术后生存预后情况。根据患者术后五年时的生存预后，分成生存组与死亡组，采用t检验和Logistic回归方法分别比较两组患者不同指标之间的差异，并绘制受试者工作特征曲线(ROC曲线)预测患者的预后。结果　共113例患者入组，RP术后五年存活78例（69.0%），死亡35例（31.0%），单因素分析结果显示，死亡组患者的平均CCI、年龄、临床分期、病理分级均显著高于存活组患者（P<0.05），将这4项指标纳入多因素Logistic回归模型进行分析。结果显示这4项指标均与患者RP术后5年生存预后相关。绘制这4项指标以及将4者联合预测RP术后预后的ROC曲线，结果显示CCI、年龄、临床分期、病理分级以及4者联合预测概率的曲线下面积（95%CI）依次是0.699（0.591-0.807）、0.665（0.557-0.773）、0.688（0.581-0.795）、0.671 （0.565-0.776）、0.814 （0.730-0.898）。结论　单独使用CCI预测患者RP术后的预后具有一定的预测价值；将CCI结合患者的年龄、临床分期以及病理分级，能很好的预测RP术后的预后。

Abstract:

Objective　To investigate the value of Charlson comorbidity index (CCI) in evaluating the prognosis of prostate cancer patients after radical prostatectomy (RP). 　Methods　The clinical data of prostate cancer patients, who underwent RP surgery in Northern Jiangsu People’s Hospital from January 2008 to January 2013, were retrospectively analyzed. The clinical data, including age, body mass index (BMI), previous underlying disease and prognosis, pre-operative prostate specific antigen (PSA), clinical stage, pathological grade, operation time, amount of surgical blood loss, postoperative pathological margin positivity, and postoperative survival prognosis, were collected. Based on five-year survival after surgery, the patients were divided into survival group and death group. The difference of different indexes between the two groups was compared by t test and Logistic regression method, and a receiver operating characteristic curve (ROC curve) was drawn to predict the prognosis of the patients. 　Results　A total of 113 patients were enrolled, 78 patients (69.0%) survived and 35 patients (31.0%) died. Univariate analysis revealed that average CCI, age, clinical stage, and pathological grade of the patients in the death group were significantly higher than those in the survival group (P<0.05). These four indicators showed association with five-year survival prognosis after RP when they were included in the multivariate logistic regression model for analysis. ROC curves were drawn for these four individual indicators and their combination to predict prognosis after RP. The results revealed that the area under the curve (95% CI) of CCI, age, clinical stage, pathological grade, and the combination of the four indicators were 0.699 (0.591-0.807), 0.665 (0.557-0.773), 0.688 (0.581-0.795), 0.671 (0.565-0.776), and 0.814 (0.730-0.898), respectively. 　Conclusions　The use of CCI alone to predict the prognosis of prostate cancer patients after RP has a certain predictive value. Combination of CCI with age, clinical stage, and pathological grade of the patients can better predict the prognosis after RP.