Koppie T M, Grossfeld G D, Miller D, Yu J, Stier D, Broering J M, Lubeck D, Henning J M, Flanders S C, Carroll P R
Department of Urology, Center for Urologic Outcomes, University of California-San Francisco, San Francisco, California, USA.
J Urol. 2000 Jul;164(1):81-8.
We determined the demographic and clinical profile of men who elect surveillance as the initial management of prostate cancer as well as the incidence and predictors of secondary treatment of these patients.
The Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE) is a national disease registry of patients with various stages and treatments of prostate cancer. Using this database of 4,458 men we identified 329 (8.2%) who elected surveillance as the initial management of prostate cancer. Patients choosing watchful waiting were compared to other CaPSURE participants using the chi-square test. The likelihood of treatment initiation in the watchful waiting group was calculated using the Kaplan-Meier method. After adjusting for patient age, race, prostate specific antigen (PSA) at diagnosis, clinical T stage and total Gleason score the Cox proportional hazards regression model was used to determine significant predictors of treatment initiation.
Compared with others in the database, patients on watchful waiting were more likely to be 75 years old or older (51% versus 16%, p <0.001), white (93% versus 85%, p <0.001), and have lower serum PSA (p <0.001), organ confined disease (97% versus 88%, p <0.001) and a total Gleason score of 7 or less (97% versus 88%, p <0.001). In the watchful waiting group there was a 52% likelihood of treatment initiation within 5 years of the diagnosis. Significant predictors of secondary treatment were age younger than 65 years and elevated serum PSA at diagnosis. Neither race, extraprostatic stage cT3 disease nor higher total Gleason score was a significant predictor of treatment.
Men who elect initial watchful waiting for prostate cancer tend to be older, have lower serum PSA and more favorable disease characteristics than those who seek treatment. PSA at diagnosis is the dominant factor for predicting secondary treatment.
我们确定了选择监测作为前列腺癌初始治疗方法的男性患者的人口统计学和临床特征，以及这些患者二次治疗的发生率和预测因素。
前列腺癌战略泌尿学研究计划（CaPSURE）是一个关于前列腺癌不同分期和治疗方法的全国性疾病登记系统。利用这个包含4458名男性患者的数据库，我们确定了329名（8.2%）选择监测作为前列腺癌初始治疗方法的患者。采用卡方检验，将选择观察等待的患者与CaPSURE的其他参与者进行比较。使用Kaplan-Meier方法计算观察等待组开始治疗的可能性。在对患者年龄、种族、诊断时的前列腺特异性抗原（PSA）、临床T分期和总Gleason评分进行校正后，使用Cox比例风险回归模型确定开始治疗的显著预测因素。
与数据库中的其他患者相比，选择观察等待的患者更可能年龄在75岁及以上（51%对16%，p<0.001）、为白人（93%对85%，p<0.001），且血清PSA较低（p<0.001）、疾病局限于器官内（97%对88%，p<0.001）以及总Gleason评分为7分或更低（97%对88%，p<0.001）。在观察等待组中，诊断后5年内开始治疗的可能性为52%。二次治疗的显著预测因素为年龄小于65岁以及诊断时血清PSA升高。种族、前列腺外分期cT3疾病和更高的总Gleason评分均不是治疗的显著预测因素。
与寻求治疗的男性相比，选择对前列腺癌进行初始观察等待的男性往往年龄更大、血清PSA更低且疾病特征更有利。诊断时的PSA是预测二次治疗的主要因素。
