Soulié M, Villers A, Richaud P, Prapotnich D, Ruffion A, Grosclaude P
Service de Chirurgie Urologique et d'Andrologie, CHU Rangueil, 31403 Toulouse.
Prog Urol. 2001 Dec;11(6):1195-204.
The treatment decision taken by a multidisciplinary meeting for patients with localized prostate cancer must take into account the clinical stage of the cancer and its histological characteristics, but also the patient's age, general state and any concomitant diseases, as treatment is only beneficial when it induces a reduction of morbidity and specific mortality. The specific survival with or without recurrence after treatment for localized prostate cancer is long, at least more than 10 years. Curative treatment is generally not proposed to men with localized prostate cancer when his probability of survival related to a competitive morbidity (intercurrent medical disease) is estimated to be less than 10 years. The objective of this study was to measure the increase or reduction of the survival probability of a patient with localized prostate cancer according to his competitive morbidity, based on the mean life expectancy of the general population.
Review of the literature.
Studies describing the natural history of prostate cancer show that the impact of treatment on morbidity of the cancer (local and/or metastatic) requires a life expectancy of about 8 to 10 years. The impact of a treatment on specific survival requires a life expectancy of about 13 to 15 years. The exact prevalence of diseases coexisting with prostate cancer is unknown. In the USA, The Index of Coexisting Disease (ICD), which takes into account 14 diseases, appears to be the most reliable tool to measure the competitive morbidity in patients with localized prostate cancer. Each disease is classified into 4 levels of severity (score 0 to 3). A table indicates estimated life expectancies by age-group and by ICD score. All men with a high score (2 to 3) die within 10 years after diagnosis, men with a score of 0 have a better estimated life expectancy according to age than that of the general population.
The upper age limit, theoretically set at 70 years, in order to propose curative treatment for localized prostate cancer needs to be reviewed (the mean life expectancy for a 70-year-old man is 12.9 years in France). According to the ICD, the life expectancy at 70 years is 14.8 years in the case of a score of 0 and 8.4 years in the case of a score of 2. In the case of a score of 2, the impact of curative treatment on localized prostate cancer would be real on morbidity, but not on specific mortality.
多学科会议为局限性前列腺癌患者做出的治疗决策必须考虑癌症的临床分期及其组织学特征，还要考虑患者的年龄、一般状况和任何伴随疾病，因为只有当治疗能降低发病率和特定死亡率时才有益。局限性前列腺癌治疗后有无复发的特定生存期很长，至少超过10年。当局限性前列腺癌男性患者因竞争性发病（并发内科疾病）导致的生存概率估计小于10年时，一般不建议进行根治性治疗。本研究的目的是根据局限性前列腺癌患者的竞争性发病情况，基于一般人群的平均预期寿命，来衡量其生存概率的增加或降低。
文献综述。
描述前列腺癌自然史的研究表明，治疗对癌症（局部和/或转移性）发病率的影响需要约8至10年的预期寿命。治疗对特定生存期的影响需要约13至15年的预期寿命。与前列腺癌并存疾病的确切患病率尚不清楚。在美国，考虑14种疾病的并存疾病指数（ICD）似乎是衡量局限性前列腺癌患者竞争性发病情况最可靠的工具。每种疾病分为4个严重程度级别（评分0至3）。一个表格显示了按年龄组和ICD评分的预期寿命估计值。所有高分（2至3）男性在诊断后10年内死亡，评分为0的男性根据年龄的预期寿命估计比一般人群更好。
为局限性前列腺癌提议进行根治性治疗时理论上设定的70岁上限需要重新审视（在法国，70岁男性的平均预期寿命为12.9年）。根据ICD，评分为0时70岁的预期寿命为14.8年，评分为2时为8.4年。评分为2时，根治性治疗对局限性前列腺癌发病率会有实际影响，但对特定死亡率没有影响。
