Magheli Ahmed, Rais-Bahrami Soroush, Humphreys Elizabeth B, Peck Hugh J, Trock Bruce J, Gonzalgo Mark L
Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
J Urol. 2007 Nov;178(5):1933-7; discussion 1937-8. doi: 10.1016/j.juro.2007.07.016. Epub 2007 Sep 17.
Increased age has been suggested to predict worse clinical outcomes in patients with prostate cancer. An explanation that was proposed for this observation is that it is due to inherent differences in the biological properties of prostate cancer in older men. Stage migration, prostate specific antigen and prostate biopsy pathology are variables that may confound the interpretation of age as an independent prognosticator of outcomes following radical prostatectomy.
Matched pairs analysis was performed comparing the 3 age cohorts 46 to 55, 56 to 65 and older than 65 years to a cohort of 435 patients who were 45 years or younger based on propensity scores calculated with all known preoperative variables. Postoperative clinical and pathological characteristics were compared among the 4 matched age cohorts. A Cox hazards model was used to compare time to prostate specific antigen recurrence across the different age cohorts and the actuarial risk of recurrence was calculated using Kaplan-Meier and log rank survivor analyses.
Younger patients showed lower grade disease (p <0.001), and lower rates of positive surgical margin rates (p = 0.035) and extraprostatic extension (p <0.001) but they did not have higher rates of lymph node involvement (p = 0.85) or seminal vesicle invasion (p = 0.56). Kaplan-Meier analysis showed no significant differences in biochemical recurrence across the age cohorts (log rank 0.38). On multivariate analysis prostatectomy Gleason score, pathological stage, positive surgical margins (each p <0.001) and preoperative prostate specific antigen (p = 0.04) were independently predictive of biochemical recurrence.
We report that increased age is not associated with worse biochemical outcomes following radical prostatectomy and it should not be considered an independent prognosticator for disease recurrence. Rather, age is a surrogate for known predictors of biochemical recurrence following surgery.
有研究表明，年龄增加预示着前列腺癌患者的临床预后更差。针对这一观察结果提出的一种解释是，这是由于老年男性前列腺癌生物学特性的内在差异所致。分期迁移、前列腺特异性抗原和前列腺活检病理是可能混淆将年龄作为根治性前列腺切除术后预后独立预测指标的解释的变量。
基于所有已知术前变量计算的倾向评分，对46至55岁、56至65岁和65岁以上这3个年龄组与435名45岁及以下的患者队列进行配对分析。比较4个匹配年龄组的术后临床和病理特征。使用Cox风险模型比较不同年龄组前列腺特异性抗原复发时间，并使用Kaplan-Meier和对数秩生存分析计算复发的精算风险。
较年轻患者的疾病分级较低（p<0.001），手术切缘阳性率（p = 0.035）和前列腺外侵犯率较低（p<0.001），但他们的淋巴结受累率（p = 0.85）或精囊侵犯率（p = 0.56）并不更高。Kaplan-Meier分析显示，各年龄组之间生化复发无显著差异（对数秩0.38）。多因素分析显示，前列腺切除术后Gleason评分、病理分期、手术切缘阳性（各p<0.001）和术前前列腺特异性抗原（p = 0.04）是生化复发的独立预测指标。
我们报告，年龄增加与根治性前列腺切除术后较差的生化预后无关，不应将其视为疾病复发的独立预测指标。相反，年龄是手术后生化复发已知预测指标的替代指标。
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