Ryan Charles J, Elkin Eric P, Cowan Janet, Carroll Peter R
Department of Medicine, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California 94143, USA.
Cancer. 2007 Jul 1;110(1):81-6. doi: 10.1002/cncr.22736.
The current study utilized the CaPSURE disease registry to describe the natural history, initial treatment, and factors correlated with mortality in patients who were diagnosed with bony metastatic disease (M+) at the time of initial presentation.
Treatment patterns at the time of diagnosis were analyzed. Two Cox proportional hazards models were developed, with outcomes of all cause-specific mortality and prostate cancer-specific mortality in patients with M+ disease. Clinical and sociodemographic variables were included in a backward stepwise procedure to identify predictors of mortality.
Of 12,005 patients diagnosed between 1990-2004, 284 (2.4%) were diagnosed with M+ disease. After a median follow-up period of 3.8 years, 107 patients (39%) died. Of those who died, 68 (64%) died of causes related to prostate cancer, whereas 39 (36%) had died of causes not related to prostate cancer. The 5-year survival of all patients was 71% and the median survival had not been reached at the time of last follow-up. Approximately 84% of patients received some form of hormonal therapy within 6 months of diagnosis, the use of which increased throughout the study period. Prostate cancer-specific mortality was found to be correlated with the presence of comorbid illness, younger age at diagnosis, and a Gleason score >7 in the primary tumor.
Patients with M+ prostate cancer have a protracted natural history and a median survival that exceeds 5 years. Hormonal therapy is the mainstay for such patients. Comorbid illness, young age at diagnosis, and cancer grade appear to negatively affect the disease-specific survival.
本研究利用CaPSURE疾病登记库来描述初次就诊时被诊断为骨转移性疾病（M+）患者的自然病程、初始治疗情况以及与死亡率相关的因素。
分析诊断时的治疗模式。构建了两个Cox比例风险模型，以M+疾病患者的全因特异性死亡率和前列腺癌特异性死亡率为结局指标。临床和社会人口统计学变量纳入向后逐步回归程序以确定死亡率的预测因素。
在1990年至2004年间诊断的12,005例患者中，284例（2.4%）被诊断为M+疾病。中位随访期3.8年后，107例患者（39%）死亡。在死亡患者中，68例（64%）死于与前列腺癌相关的原因，而39例（36%）死于与前列腺癌无关的原因。所有患者的5年生存率为71%，末次随访时中位生存期尚未达到。约84%的患者在诊断后6个月内接受了某种形式的激素治疗，其使用在整个研究期间有所增加。发现前列腺癌特异性死亡率与合并症的存在、诊断时年龄较小以及原发肿瘤Gleason评分>7相关。
M+前列腺癌患者自然病程迁延，中位生存期超过5年。激素治疗是这类患者的主要治疗方法。合并症、诊断时年龄较小以及癌症分级似乎对疾病特异性生存有负面影响。
