Tewari Ashutosh, Divine George, Chang Peter, Shemtov M Mendel, Milowsky Matthew, Nanus David, Menon Mani
Brady Urologic Health Center, New York Presbyterian Hospital and Robotic Prostatectomy and Urologic Oncology Outcomes, Weill Medical College of Cornell University, New York, New York 10021, USA.
J Urol. 2007 Mar;177(3):911-5. doi: 10.1016/j.juro.2006.10.040.
We performed a retrospective cohort study using propensity score analysis to calculate long-term survival in patients with prostate cancer with Gleason score 8 or greater who were treated with conservative therapy, radiation therapy and radical prostatectomy.
Between January 1, 1980 and December 31, 1997, 3,159 patients in the Henry Ford Health System were diagnosed with clinically localized prostate cancer. Of these patients 453 had a Gleason score of 8 or greater in the biopsy specimen and they were the cohort. The end points were overall and prostate cancer specific survival. Propensity score analysis was used to more precisely compare the 3 treatments of observation, radiation and radical prostatectomy. Median patient followup was longer in the radical prostatectomy arm than in the conservative treatment and radiation therapy arms (68 months vs 52 and 54, respectively).
Of the 453 patients 197 (44%) were treated conservatively, 137 (30%) received radiation therapy and 119 (26%) underwent radical prostatectomy. Using propensity scoring analysis median overall survival for conservative therapy, radiation and radical prostatectomy was 5.2, 6.7 and 9.7 years, respectively. Median cancer specific survival was 7.8 years for conservative therapy and more than 14 years for radiation therapy and radical prostatectomy. The risk of cancer specific death following radical prostatectomy was 68% lower than for conservative treatment and 49% lower than for radiation therapy (p<0.001 and 0.053, respectively).
Survival of men with high grade prostate cancer can be improved by radical prostatectomy or radiation therapy.
我们进行了一项回顾性队列研究，采用倾向评分分析来计算接受保守治疗、放射治疗和根治性前列腺切除术的 Gleason 评分 8 分及以上的前列腺癌患者的长期生存率。
在 1980 年 1 月 1 日至 1997 年 12 月 31 日期间，亨利福特医疗系统的 3159 名患者被诊断为临床局限性前列腺癌。其中 453 名患者活检标本的 Gleason 评分为 8 分及以上，他们构成了该队列。终点指标为总生存率和前列腺癌特异性生存率。倾向评分分析用于更精确地比较观察、放疗和根治性前列腺切除术这三种治疗方法。根治性前列腺切除术组患者的中位随访时间比保守治疗组和放射治疗组更长（分别为 68 个月、52 个月和 54 个月）。
453 名患者中，197 名（44%）接受了保守治疗，137 名（30%）接受了放射治疗，119 名（26%）接受了根治性前列腺切除术。使用倾向评分分析，保守治疗、放疗和根治性前列腺切除术的中位总生存率分别为 5.2 年、6.7 年和 9.7 年。保守治疗的中位癌症特异性生存率为 7.8 年，放疗和根治性前列腺切除术的中位癌症特异性生存率均超过 14 年。根治性前列腺切除术后癌症特异性死亡风险比保守治疗低 68%，比放射治疗低 49%（分别为 p<0.001 和 0.053）。
根治性前列腺切除术或放射治疗可提高高级别前列腺癌男性患者的生存率。
