Wu Hongyan, Sun Leon, Moul Judd W, Wu Hong Yu, McLeod David G, Amling Christopher, Lance Raymond, Kusuda Leo, Donahue Timothy, Foley John, Chung Andrew, Sexton Wade, Soderdahl Douglas
Department of Surgery, Center for Prostate Disease Research, Uniformed Services University of the Health Sciences, National Naval Medical Center, Bethesda, MD, USA.
J Urol. 2004 Mar;171(3):1111-6. doi: 10.1097/01.ju.0000113300.74132.8b.
Watchful waiting remains an important treatment option for some patients with localized prostate cancer. We defined the demographic, clinical and outcome features of men selecting watchful waiting as an initial treatment strategy, and determined factors predictive of eventual progression to secondary treatment.
Of 8390 patients diagnosed with prostate cancer from 1990 to 2001 in the Department of Defense Center for Prostate Disease Research Database, 1158 patients chose watchful waiting as initial treatment. The demographic and clinical differences between patients on watchful waiting and those choosing other initial treatments were compared using the chi-square test. Secondary treatment-free survival according to various prognostic factors was plotted using the Kaplan-Meier method and differences were tested using the log rank test. A multivariate Cox proportional hazards regression analysis was performed to determine which factors were independent predictors of secondary treatment.
Compared to other patients, those selecting watchful waiting were older, had lower prostate specific antigen (PSA) at diagnosis, and were more likely to have lower stage (cT1) and lower grade (Gleason sum 7 or less) cancers. Age, PSA and clinical stage were all significant and independent predictors of secondary treatment. The relative risk of secondary treatment can be expressed as EXP (-0.034 x age at diagnosis + 0.284 x LOG (diagnostic PSA) + 0.271 x clinical stage T2 + 0.264 x clinical stage T3).
Men who elect watchful waiting as initial management for prostate cancer are older with lower Gleason sums and serum PSA. In these men, age at diagnosis, serum PSA and clinical stage are the most significant predictors of requiring or selecting secondary treatment.
对于一些局限性前列腺癌患者，密切观察等待仍然是一种重要的治疗选择。我们定义了选择密切观察等待作为初始治疗策略的男性患者的人口统计学、临床和预后特征，并确定了预测最终进展至二线治疗的因素。
在国防部前列腺疾病研究数据库中，1990年至2001年诊断为前列腺癌的8390例患者中，1158例患者选择密切观察等待作为初始治疗。使用卡方检验比较密切观察等待患者与选择其他初始治疗患者之间的人口统计学和临床差异。使用Kaplan-Meier方法绘制根据各种预后因素的无二线治疗生存率，并使用对数秩检验测试差异。进行多变量Cox比例风险回归分析以确定哪些因素是二线治疗的独立预测因素。
与其他患者相比，选择密切观察等待的患者年龄较大，诊断时前列腺特异性抗原（PSA）较低，且更有可能患有较低分期（cT1）和较低分级（Gleason总分7分或更低）的癌症。年龄、PSA和临床分期均为二线治疗的显著且独立的预测因素。二线治疗的相对风险可表示为EXP（-0.034×诊断时年龄+0.284×LOG（诊断时PSA）+0.271×临床分期T2+0.264×临床分期T3）。
选择密切观察等待作为前列腺癌初始治疗的男性年龄较大，Gleason总分和血清PSA较低。在这些男性中，诊断时年龄、血清PSA和临床分期是需要或选择二线治疗的最显著预测因素。
