经筛查发现的前列腺癌患者与经医生转诊并接受根治性前列腺切除术的患者的生存结果：早期结果

Survival results in patients with screen-detected prostate cancer versus physician-referred patients treated with radical prostatectomy: early results.

作者信息

Roehl Kimberly A, Eggener Scott E, Loeb Stacy, Smith Norm D, Antenor Jo Ann V, Catalona William J

机构信息

Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63105, USA.

出版信息

Urol Oncol. 2006 Nov-Dec;24(6):465-71. doi: 10.1016/j.urolonc.2005.11.039.

DOI:10.1016/j.urolonc.2005.11.039

PMID:17138126

Abstract

OBJECTIVE

Screening using a standardized protocol may improve outcomes of patients undergoing treatment for prostate cancer. We compared the 7- year progression-free survival rates after radical retropubic prostatectomy in patients whose prostate cancer was detected through a formal screening program with those of patients referred for treatment by other physicians who did not use a standardized screening/referral protocol.

METHODS

A single surgeon (W.J.C.) performed radical retropubic prostatectomy in 3,177 consecutive patients between 1989 and 2003. Of these patients, 464 had cancer detected in a screening study, and 2,713 were referred from outside institutions. We compared the screened and referred cohorts for age at surgery, clinical stage, pathologic stage, Gleason sum, preoperative prostate-specific antigen (PSA) levels, and adjuvant radiation therapy. Kaplan-Meier product limit estimates were used to calculate 7-year progression-free probabilities, and Cox proportional hazards models were used to determine the clinical and pathologic parameters associated with cancer progression in each group.

RESULTS

The overall 7-year progression-free survival rates were 83% for the screened patients compared with 77% for the referred patients (P = 0.002). Preoperative PSA, Gleason sum, clinical stage, pathologic stage, and adjuvant radiotherapy were all significantly associated with cancer progression. There was a significantly higher proportion of referred patients with a preoperative PSA > or =10, Gleason sum > or =7, and nonorgan-confined disease.

CONCLUSIONS

Patients with screened-detected prostate cancer have more favorable clinical and pathologic features, and 7-year progression-free survival rates than referred patients. On multivariate analysis, including other clinical variables, screening status was a significant independent predictor of biochemical outcome.

摘要

目的

采用标准化方案进行筛查可能会改善接受前列腺癌治疗患者的预后。我们比较了通过正式筛查项目检测出前列腺癌的患者与由未使用标准化筛查/转诊方案的其他医生转诊来接受治疗的患者在耻骨后根治性前列腺切除术后的7年无进展生存率。

方法

1989年至2003年间，同一位外科医生（W.J.C.）对3177例连续患者实施了耻骨后根治性前列腺切除术。其中，464例患者的癌症在筛查研究中被检测出，2713例患者由外部机构转诊而来。我们比较了筛查组和转诊组患者的手术年龄、临床分期、病理分期、Gleason评分、术前前列腺特异性抗原（PSA）水平以及辅助放疗情况。采用Kaplan-Meier乘积限估计法计算7年无进展概率，并使用Cox比例风险模型确定每组中与癌症进展相关的临床和病理参数。