title: Older patients with low Charlson score and high-risk prostate cancer benefit from radical prostatectomy.
abstract: BACKGROUND
  The aim of the study was to identify the appropriate level of Charlson comorbidity index (CCI) in older patients (>70 years) with high-risk prostate cancer (PCa) to achieve survival benefit following radical prostatectomy (RP).
  
  
  METHODS
  We retrospectively analyzed 1008 older patients (>70 years) who underwent RP with pelvic lymph node dissection for high-risk prostate cancer (preoperative prostate-specific antigen >20 ng/mL or clinical stage ≥T2c or Gleason ≥8) from 14 tertiary institutions between 1988 and 2014. The study population was further grouped into CCI < 2 and ≥2 for analysis. Survival rate for each group was estimated with Kaplan-Meier method and competitive risk Fine-Gray regression to estimate the best explanatory multivariable model. Area under the curve (AUC) and Akaike information criterion were used to identify ideal 'Cut off' for CCI.
  
  
  RESULTS
  The clinical and cancer characteristics were similar between the two groups. Comparison of the survival analysis using the Kaplan-Meier curve between two groups for non-cancer death and survival estimations for 5 and 10 years shows significant worst outcomes for patients with CCI ≥ 2. In multivariate model to decide the appropriate CCI cut-off point, we found CCI 2 has better AUC and p value in log rank test.
  
  
  CONCLUSIONS
  Older patients with fewer comorbidities harboring high-risk PCa appears to benefit from RP. Sicker patients are more likely to die due to non-prostate cancer-related causes and are less likely to benefit from RP.
authors.affiliation: Department of Urology, Institute Mutualiste Monsouris, 42, Bd Jourdan, 75674, Paris Cedex 14, France.
authors.forename: A
authors.initials: A
authors.lastname: Sivaraman
authors.affiliation: Department of Urology, Institute Mutualiste Monsouris, 42, Bd Jourdan, 75674, Paris Cedex 14, France.
authors.forename: G
authors.initials: G
authors.lastname: Ordaz Jurado
authors.affiliation: Department of Urology, Institute Mutualiste Monsouris, 42, Bd Jourdan, 75674, Paris Cedex 14, France.
authors.forename: X
authors.initials: X
authors.lastname: Cathelineau
authors.affiliation: Department of Urology, Institute Mutualiste Monsouris, 42, Bd Jourdan, 75674, Paris Cedex 14, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: P
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: S
authors.initials: S
authors.lastname: Joniau
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bianchi
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: A
authors.initials: A
authors.lastname: Briganti
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: M
authors.initials: M
authors.lastname: Spahn
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: P
authors.initials: P
authors.lastname: Bastian
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: J
authors.initials: J
authors.lastname: Chun
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: P
authors.initials: P
authors.lastname: Chlosta
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: P
authors.initials: P
authors.lastname: Gontero
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: M
authors.initials: M
authors.lastname: Graefen
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: R
authors.initials: R
authors.lastname: Jeffrey Karnes
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: G
authors.initials: G
authors.lastname: Marchioro
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: B
authors.initials: B
authors.lastname: Tombal
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: L
authors.initials: L
authors.lastname: Tosco
authors.affiliation: EMPaCT Database, Tempe, AZ, USA.
authors.forename: H Henk
authors.initials: HH
authors.lastname: van der Poel
authors.affiliation: Department of Urology, Institute Mutualiste Monsouris, 42, Bd Jourdan, 75674, Paris Cedex 14, France. rafaelsanchezsalas.imm@gmail.com.|EMPaCT Database, Tempe, AZ, USA. rafaelsanchezsalas.imm@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Sanchez-Salas
mesh_terms: D000368:Aged; D001706:Biopsy; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D060787:Neoplasm Grading / Q000379:methods*; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Charlson comorbidity index; High-risk prostate cancer; Radical prostatectomy; Survival benefit