Post P N, Hansen B E, Kil P J, Janssen-Heijnen M L, Coebergh J W
Comprehensive Cancer Centre South, Eindhoven, Department of Epidemiology & Biostatistics, Erasmus University Rotterdam, The Netherlands.
BJU Int. 2001 Jun;87(9):821-6. doi: 10.1046/j.1464-410x.2001.02189.x.
To investigate which prognostic factors apply in patients with localized prostate cancer diagnosed after the introduction of prostate-specific antigen (PSA) testing, as comorbidity has significant prognostic value for patients who were diagnosed with localized prostate cancer in the 1970s. Patients and methods Using the Eindhoven Cancer Registry, we assessed a population-based cohort of patients aged < 75 years with localized (T1-T3M0) prostate cancer diagnosed between 1993 and 1995 in a defined area with 2 million inhabitants in the southern Netherlands (n = 894). After a mean follow-up of 2.9 years, overall survival was modelled by Cox regression analyses.
Comorbidity was the most important prognostic factor, especially for those aged < 70 years; at 60 years old, patients with one concomitant disease were twice as likely to die than those with no comorbidity (95% confidence interval, CI, 1.0-4.3), whereas the hazard ratio (HR) was 7.2 (3.1-16.6) for two or more diseases. This was not caused by a reduced use of curative treatment for these patients. At the age of 74 years, comorbidity was no longer a significant prognostic factor. Poor differentiation of the tumour was also an important prognostic factor at all ages; this became increasingly apparent 2 years after diagnosis (HR 3.4, CI 1.5-7.7). Conclusion Comorbidity had a decisive influence on the prognosis for patients with localized prostate cancer. Because this effect was stronger in younger patients the assessment of comorbidity seems most important when evaluating the risk of early death.
研究在引入前列腺特异性抗原（PSA）检测后诊断出的局限性前列腺癌患者中，哪些预后因素适用，因为合并症对20世纪70年代诊断出的局限性前列腺癌患者具有显著的预后价值。患者与方法利用埃因霍温癌症登记处，我们评估了1993年至1995年期间在荷兰南部一个有200万居民的特定区域诊断出的年龄小于75岁的局限性（T1-T3M0）前列腺癌患者的基于人群的队列（n = 894）。经过平均2.9年的随访，通过Cox回归分析对总生存期进行建模。
合并症是最重要的预后因素，尤其是对于年龄小于70岁的患者；在60岁时，患有一种伴随疾病的患者死亡可能性是无合并症患者的两倍（95%置信区间，CI，1.0 - 4.3），而对于两种或更多种疾病，风险比（HR）为7.2（3.1 - 16.6）。这并非由于这些患者减少了根治性治疗的使用。在74岁时，合并症不再是显著的预后因素。肿瘤分化差在所有年龄段也是一个重要的预后因素；在诊断后2年这一点变得越来越明显（HR 3.4，CI 1.5 - 7.7）。结论合并症对局限性前列腺癌患者的预后具有决定性影响。由于这种影响在年轻患者中更强，在评估早期死亡风险时，合并症的评估似乎最为重要。
