Jonsson E, Sigbjarnarson H P, Tomasson J, Benediktsdottir K R, Tryggvadottir L, Hrafnkelsson J, Olafsdottir E J, Tulinius H, Jonasson J G
Department of Urology, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Scand J Urol Nephrol. 2006;40(4):265-71. doi: 10.1080/00365590600750110.
To investigate adenocarcinoma of the prostate in a single population with an extended follow-up period.
Using the Icelandic Cancer Registry, we identified all Icelandic men diagnosed with prostate cancer between 1983 and 1987. Disease stage, initial treatment and follow-up information were obtained from hospital records and death certificates. A critical evaluation was made of the accuracy of the death certificates regarding prostate cancer. All available histology information was reviewed and graded according to the Gleason grading system.
A total of 414 men were diagnosed with adenocarcinoma of the prostate. Of these, 370 were alive at the time of diagnosis and stage could be determined. Four stage groups were defined: focal incidental (n=50); localized (n=164); local advanced (n=32); and metastatic disease (n=124). The mean age at diagnosis was 74.4 years (range 53-94 years). The combined Gleason score was 2-5 in 89, 6-7 in 117, 8-10 in 117 and unknown in 47 cases. The median follow-up period for the group was 6.15 years (range 0.3-19.8 years). Thirty men received treatment with curative intent: radiation therapy, n=20; and radical prostatectomy, n=10. A total of 334 patients died during the follow-up period, of whom 168 (50%) died of prostate cancer. Prostate cancer-specific survival at 10 and 15 years was 100% and 90.6%, respectively for focal incidental cancer; 73.1% and 60.8% for men with localized disease; 23.4% and 11.7% for local advanced disease; and 6.81% and 5.45% for metastatic disease. A Cox multivariate analysis showed age, stage and Gleason score to be independent predictors of prostate cancer death. A total of 104 patients with localized disease and a Gleason score of <or=7 received deferred treatment. The cause-specific survival for this group was 95.6%, 86.5% and 79.2% at 5, 10 and 15 years, respectively. Death certificates were judged to be accurate with regard to prostate cancer in nearly all instances (96%).
During an extended follow-up period, half of all patients with prostate cancer died from the disease. Males with localized disease and a favorable tumor grade fared well with deferred treatment. However, a higher stage and grade were associated with substantial prostate cancer mortality. Death certificates were accurate as far as prostate cancer was concerned.
在单一人群中对前列腺腺癌进行延长随访期的研究。
利用冰岛癌症登记处，我们确定了1983年至1987年间所有被诊断为前列腺癌的冰岛男性。疾病分期、初始治疗及随访信息来自医院记录和死亡证明。对死亡证明中关于前列腺癌的准确性进行了严格评估。根据Gleason分级系统对所有可用的组织学信息进行审查和分级。
共有414名男性被诊断为前列腺腺癌。其中，370名在诊断时存活且分期可确定。定义了四个分期组：局灶偶然癌（n = 50）；局限性癌（n = 164）；局部进展癌（n = 32）；转移性疾病（n = 124）。诊断时的平均年龄为74.4岁（范围53 - 94岁）。Gleason总分在89例中为2 - 5分，117例中为6 - 7分，117例中为8 - 10分，47例未知。该组的中位随访期为6.15年（范围0.3 - 19.8年）。30名男性接受了根治性治疗：放疗，n = 20；根治性前列腺切除术，n = 10。随访期间共有334例患者死亡，其中168例（50%）死于前列腺癌。局灶偶然癌10年和15年的前列腺癌特异性生存率分别为100%和90.6%；局限性疾病男性分别为73.1%和60.8%；局部进展癌分别为23.4%和11.7%；转移性疾病分别为6.81%和5.45%。Cox多变量分析显示年龄、分期和Gleason评分是前列腺癌死亡的独立预测因素。104例局限性疾病且Gleason评分≤7分的患者接受了延期治疗。该组的病因特异性生存率在5年、10年和15年分别为95.6%、86.5%和79.2%。几乎在所有情况下（96%），死亡证明被判定为关于前列腺癌是准确的。
在延长的随访期内，所有前列腺癌患者中有一半死于该疾病。局限性疾病且肿瘤分级良好的男性延期治疗效果良好。然而，较高的分期和分级与较高的前列腺癌死亡率相关。就前列腺癌而言，死亡证明是准确的。
