Núcleo de Saúde Coletiva, Coordenação de Ensino e Pesquisa, Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2010 Apr;44(2):344-52. doi: 10.1590/s0034-89102010000200016.
To assess survival rates and clinical (pretreatment) prognostic factors in patients with clinically localized adenocarcinoma of the prostate.
Hospital cohort including 258 patients registered in the National Cancer Institute, in the city of Rio de Janeiro, southeastern Brazil, from 1990 to 1999. Five- and ten-year survival functions were estimated using the Kaplan-Meier estimator from the histological diagnosis (initial time of follow-up) to death due to prostate cancer (events). Prognostic factors were assessed using hazard ratios (HR) with confidence intervals of 95%, following the Cox's proportional hazards model. The assumption of proportionality of risks was tested using Schoenfeld residuals and the impact of outliers in the model fitness was analyzed using martingale and score residuals.
Of 258 patients studied, 46 died during follow-up. The overall five-year and ten-year survival rates were 88% and 71%, respectively. A Gleason score higher than 6, PSA levels higher than 40 ng/mL, B2 stage, and white skin color were independent markers of poor prognosis.
Gleason score, digital rectal examination and PSA levels have great predictive power and must be used in pretreatment risk stratification of patients with localized prostate cancer.
评估临床局限性前列腺腺癌患者的生存率和临床（治疗前）预后因素。
该研究为医院队列研究，共纳入了 258 名于 1990 年至 1999 年在巴西东南部里约热内卢市的美国国立癌症研究所登记的患者。使用 Kaplan-Meier 估计器从组织学诊断（随访初始时间）到因前列腺癌死亡（事件）来估计 5 年和 10 年的生存率。使用 Cox 比例风险模型评估预后因素，使用置信区间为 95%的风险比（HR）。使用 Schoenfeld 残差检验风险比例的同质性，使用 martingale 和 score 残差分析模型拟合中的异常值的影响。
在 258 名研究患者中，有 46 人在随访期间死亡。总的 5 年和 10 年生存率分别为 88%和 71%。Gleason 评分>6、PSA 水平>40ng/mL、B2 期和白色皮肤是预后不良的独立标志物。
Gleason 评分、直肠指检和 PSA 水平具有很强的预测能力，必须用于局限性前列腺癌患者的治疗前风险分层。
