Department of Surgery, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030, USA.
J Clin Oncol. 2011 Apr 1;29(10):1335-41. doi: 10.1200/JCO.2010.31.2330. Epub 2011 Feb 28.
To provide patients and clinicians more accurate estimates of comorbidity-specific survival stratified by patient age, tumor stage, and tumor grade.
We conducted a 10-year competing risk analysis of 19,639 men 66 years of age and older identified by the Surveillance, Epidemiology, and End Results (SEER) program linked to Medicare program files. All men were diagnosed with localized prostate cancer and received no surgery or radiation within 180 days of diagnosis. The analysis was stratified by tumor grade and stage and by age and comorbidity at diagnosis classified using the Charlson comorbidity index. Underlying causes of death were obtained from SEER.
During the first 10 years after diagnosis, men with moderately and poorly differentiated prostate cancer were more likely to die from causes other than their disease. Depending on patient age, Gleason score, and number of comorbidities present at diagnosis, 5-year overall mortality rates for men with stage T1c disease ranged from 11.7% (95% CI, 10.2% to 13.1%) to 65.7% (95% CI, 55.9% to 70.1%), and prostate cancer-specific mortality rates ranged from 1.1% (95% CI, 0.0% to 2.7%) to 16.3% (95% CI, 13.8% to 19.4%). Ten-year overall mortality rates ranged from 28.8% (95% CI, 25.3% to 32.6%) to 94.3% (95% CI, 87.4% to 100%), and prostate cancer-specific mortality rates ranged from 2.0% (95% CI, 0.0% to 5.3%) to 27.5% (95% CI, 21.5% to 36.5%).
Patients and clinicians should consider using comorbidity-specific data to estimate the threat posed by newly diagnosed localized prostate cancer and the threat posed by competing medical hazards.
为患者和临床医生提供更准确的基于患者年龄、肿瘤分期和肿瘤分级的特定合并症生存估计。
我们对通过监测、流行病学和最终结果(SEER)计划与医疗保险计划文件相关联的 19639 名 66 岁及以上男性进行了为期 10 年的竞争风险分析,所有男性均被诊断为局限性前列腺癌,并且在诊断后 180 天内未接受手术或放疗。分析按肿瘤分级和分期以及诊断时的年龄和合并症进行分层,使用 Charlson 合并症指数进行分类。死因基础来自 SEER。
在诊断后的前 10 年中,中高度分化和低分化前列腺癌患者更有可能死于非疾病原因。根据患者年龄、Gleason 评分和诊断时存在的合并症数量,T1c 期疾病男性的 5 年总死亡率范围为 11.7%(95%CI,10.2%至 13.1%)至 65.7%(95%CI,55.9%至 70.1%),前列腺癌特异性死亡率范围为 1.1%(95%CI,0.0%至 2.7%)至 16.3%(95%CI,13.8%至 19.4%)。10 年总死亡率范围为 28.8%(95%CI,25.3%至 32.6%)至 94.3%(95%CI,87.4%至 100%),前列腺癌特异性死亡率范围为 2.0%(95%CI,0.0%至 5.3%)至 27.5%(95%CI,21.5%至 36.5%)。
患者和临床医生应考虑使用特定合并症的数据来估计新诊断的局限性前列腺癌带来的威胁以及竞争医疗危害带来的威胁。