title: Survival analysis in men undergoing radical prostatectomy at an age of 70 years or older.
abstract: OBJECTIVE
  To compare comorbidity measures and to analyze survival rates in men undergoing radical prostatectomy at age 70 years or older.
  
  
  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.
authors.affiliation: Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Froehner
authors.forename: Rainer
authors.initials: R
authors.lastname: Koch
authors.forename: Rainer J
authors.initials: RJ
authors.lastname: Litz
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hakenberg
authors.forename: Sven
authors.initials: S
authors.lastname: Oehlschlaeger
authors.forename: Manfred P
authors.initials: MP
authors.lastname: Wirth
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis