Roehl Kimberly A, Eggener Scott E, Loeb Stacy, Smith Norm D, Antenor Jo Ann V, Catalona William J
Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63105, USA.
Urol Oncol. 2006 Nov-Dec;24(6):465-71. doi: 10.1016/j.urolonc.2005.11.039.
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.
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.
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.
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.
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。
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。
筛查患者的总体7年无进展生存率为83%，而转诊患者为77%（P = 0.002）。术前PSA、Gleason评分、临床分期、病理分期以及辅助放疗均与癌症进展显著相关。转诊患者中术前PSA≥10、Gleason评分≥7以及非器官局限性疾病的比例显著更高。
筛查发现前列腺癌的患者比转诊患者具有更有利的临床和病理特征以及7年无进展生存率。在多变量分析中，包括其他临床变量，筛查状态是生化结局的显著独立预测因素。
