Nam Robert K, Jewett Michael A S, Krahn Murray D, Robinette Michael A, Tsihlias John, Toi Ants, Ho Minnie, Evans Andrew, Sweet Joan, Trachtenberg John
Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Can J Urol. 2003 Jun;10(3):1891-8.
In Canada, waiting times for cancer care have been increasing, particularly for patients with genitourinary malignancies. We examined whether delay from diagnosis for patients undergoing surgery for clinically localized prostate cancer affects cancer cure rates.
We conducted a historical cohort study among 645 patients who underwent radical prostatectomy between 1987 and 1997, using biochemical recurrence (PSA elevation) and metastasis as endpoints. We examined whether patients who underwent surgery >/= months (delayed surgery group) from the date of diagnosis had reduced recurrence-free survival, compared to patients who had surgery <3 months (early surgery group) from the date of diagnosis, adjusting for grade, stage and PSA level at diagnosis.
The crude 10-year recurrence-free and metastasis-free survival rates for all patients were 71.1% (95% C.I.: 64.9% - 77.3%) and 95.3% (95% C.I.: 91.3% - 99.3%), respectively. Of the 645 patients, 189 (29.3%) had surgery >/= months after diagnosis. The median time from the date of diagnosis to surgery was 68 days (range 15 to 951 days). The 10-year recurrence-free survival was higher for patients who underwent early surgery (74.6%, 95% C.I.: 67.9% - 81.4%) compared to patients in the delayed surgery group (61.3%, 95% C.I.: 46.7% - 76.0%, p=0.05). The crude and adjusted hazard ratios for developing biochemical recurrence for patients in the delayed surgery group were 1.58 (95% C.I.: 1.0 - 2.4, p=0.04) and 1.46 (95% C.I.: 0.9 - 2.3, p=0.09), respectively, compared to patients who underwent early surgery.
There may exist a possible relationship between delays from diagnosis for radical prostatectomy and prostate cancer cure rates. These findings may have many biases that could not be properly accounted in this retrospective analysis and larger cohort analyses will be required to confirm these findings.
在加拿大，癌症治疗的等待时间一直在增加，尤其是对于泌尿生殖系统恶性肿瘤患者。我们研究了临床局限性前列腺癌手术患者从诊断到手术的延迟是否会影响癌症治愈率。
我们对1987年至1997年间接受根治性前列腺切除术的645例患者进行了一项历史性队列研究，以生化复发（PSA升高）和转移作为终点。我们比较了从诊断日期起手术时间≥[此处原文缺失具体月数]个月的患者（延迟手术组）与从诊断日期起手术时间<3个月的患者（早期手术组）的无复发生存率，同时对诊断时的分级、分期和PSA水平进行了调整。
所有患者的10年粗无复发生存率和无转移生存率分别为71.1%（95%置信区间：64.9% - 77.3%）和95.3%（95%置信区间：91.3% - 99.3%）。在645例患者中，189例（29.3%）在诊断后≥[此处原文缺失具体月数]个月接受了手术。从诊断到手术的中位时间为68天（范围15至951天）。早期手术患者的10年无复发生存率高于延迟手术组患者（74.6%，95%置信区间：67.9% - 81.4%）与（61.3%，95%置信区间：46.7% - 76.0%，p = 0.05）。与早期手术患者相比，延迟手术组患者发生生化复发的粗风险比和调整后风险比分别为1.58（95%置信区间：1.0 - 2.4，p = 0.04）和1.46（95%置信区间：0.9 - 2.3，p = 0.09）。
根治性前列腺切除术从诊断到手术的延迟与前列腺癌治愈率之间可能存在某种关系。这些发现可能存在许多偏倚，在这项回顾性分析中无法得到妥善解释，需要更大规模的队列分析来证实这些发现。
