Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Eur Urol. 2011 Jan;59(1):88-95. doi: 10.1016/j.eururo.2010.10.003. Epub 2010 Oct 14.
The efficacy of prostate cancer (PCa) treatment modalities is a subject of continuous debate.
We tested the hypothesis that significant differences in survival rates may exist among PCa patients treated with radical prostatectomy (RP), radiation therapy (RT), and observation.
DESIGN, SETTING, AND PARTICIPANTS: We focused on 404,604 patients with clinically localized PCa within 17 Surveillance, Epidemiology and End Results registries.
Competing-risks survival analyses were used to estimate cancer-specific mortality (CSM) and other-cause mortality (OCM) rates. Patients were stratified according to treatment type, age group, and PCa risk group (high risk: T2c and/or Gleason score 8-10; low to intermediate risk: all others).
The 10-yr CSM and OCM rates were 6.1% and 29.2%, respectively. In RP, RT, and observation patients, CSM rates were 3.6%, 6.5%, and 10.8% (p<0.001), respectively; OCM rates were 17.1%, 32.4%, and 48.9% (p<0.001), respectively. In low- to intermediate-risk patients, the lowest CSM (1.3-3.7%) and OCM (6.9-31.6%) rates within all age categories except octogenarians (8.9% and 62.8%, respectively) were recorded in RP. In high-risk patients, the lowest CSM (5.8-7.2%) and OCM (8.7-16.1%) rates in patients aged ≤69 yr were also recorded in RP. RT was equally favorable to RP in the 70-79 age category and appeared ideal in all octogenarian patients.
Our results showed that RP provides the most favorable survival rates in most patients. The exception is octogenarian men, in whom RT provides the best results. Finally, the least-favorable outcomes were recorded after observation. However, these findings must be interpreted within the context of the limitations of observational data.
前列腺癌（PCa）治疗方式的疗效一直是一个持续争论的话题。
我们检验了这样一个假设，即接受根治性前列腺切除术（RP）、放疗（RT）和观察治疗的 PCa 患者的生存率可能存在显著差异。
设计、地点和参与者：我们主要关注了 17 个监测、流行病学和最终结果（SEER）登记处的 404604 例临床局限性 PCa 患者。
使用竞争风险生存分析来估计癌症特异性死亡率（CSM）和其他原因死亡率（OCM）。根据治疗类型、年龄组和 PCa 风险组（高危：T2c 和/或 Gleason 评分 8-10；低-中危：其他所有）对患者进行分层。
10 年 CSM 和 OCM 率分别为 6.1%和 29.2%。在 RP、RT 和观察治疗患者中，CSM 率分别为 3.6%、6.5%和 10.8%（p<0.001），OCM 率分别为 17.1%、32.4%和 48.9%（p<0.001）。在低-中危患者中，除 80 岁以上患者外，所有年龄组的最低 CSM（1.3%-3.7%）和 OCM（6.9%-31.6%）均记录在 RP 组。在高危患者中，年龄≤69 岁的患者的最低 CSM（5.8%-7.2%）和 OCM（8.7%-16.1%）也记录在 RP 组。RT 在 70-79 岁年龄组与 RP 相当，在所有 80 岁以上患者中表现理想。
我们的研究结果表明，在大多数患者中，RP 提供了最有利的生存率。唯一的例外是 80 岁以上的男性，他们接受 RT 的效果最佳。最后，观察治疗的结果最差。然而，这些发现必须在观察数据的局限性背景下进行解释。
