Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Urology. 2011 Jul;78(1):110-5. doi: 10.1016/j.urology.2010.12.046. Epub 2011 Mar 12.
To compare clinicopathologic features and survival outcomes for men 50 years of age in relation to other age groups stratified by race to further define prostate cancer (CaP) in young men. Controversy exists regarding the appropriate age to undergo CaP screening, outcomes for early intervention, and whether there is unique age-associated tumor biology. We compared clinicopathologic features and survival outcomes for men <50 years of age in relation to other age groups stratified by race to further define CaP in young men.
A multi-institutional review of 12,081 records of patients diagnosed with CaP from 1989-2009 was conducted. Patients were stratified by age group, race, and decade of treatment. Demographic and clinicopathologic characteristics were compared across age groups using chi-square tests and analysis of variance. The primary study endpoints, time to biochemical recurrence and all-cause mortality, were compared across age groups using Kaplan-Meier estimation and univariable and multivariable Cox proportional hazards analysis.
Only 4.5% of the study sample was <50 years of age. A higher percentage of African Americans diagnosed were <50 compared with Caucasians (8.3% vs 3.3%, P<.0001). Positive family history was more prevalent in the <50 cohort (36.1% vs 22.0%, P<.0001). Despite these findings, both racial subgroups for men<50 years of age demonstrated improved clinicopathologic features than other age quartiles. Furthermore, both Kaplan-Meier and Cox proportional hazard analysis demonstrated that the <50 cohort had a lower incidence of biochemical recurrence and greater overall survival.
Race and family history appear to play a significant role in the incidence of CaP in younger men. Younger age at diagnosis is associated with more favorable outcomes and indicates that population-based screening at younger ages could potentially lead to improved survival for high-risk groups.
通过按种族分层比较 50 岁及以下男性与其他年龄组的临床病理特征和生存结果，进一步明确年轻男性前列腺癌（CaP）的特征。目前，在适当的年龄进行 CaP 筛查、早期干预的结果以及是否存在与年龄相关的独特肿瘤生物学等方面仍存在争议。我们按种族分层比较了 50 岁及以下男性与其他年龄组的临床病理特征和生存结果，以进一步明确年轻男性的 CaP。
对 1989 年至 2009 年期间诊断为 CaP 的 12081 例患者的多机构记录进行了回顾性分析。患者按年龄组、种族和治疗十年分层。使用卡方检验和方差分析比较各年龄组的人口统计学和临床病理特征。使用 Kaplan-Meier 估计和单变量及多变量 Cox 比例风险分析比较各年龄组的主要研究终点，即生化复发时间和全因死亡率。
研究样本中只有 4.5%的患者年龄<50 岁。与白人相比，<50 岁的黑人患者比例更高（8.3%比 3.3%，P<.0001）。<50 岁组阳性家族史更为常见（36.1%比 22.0%，P<.0001）。尽管存在这些差异，但<50 岁的两个种族亚组的临床病理特征均优于其他年龄四分位组。此外，Kaplan-Meier 和 Cox 比例风险分析均表明，<50 岁组生化复发的发生率较低，总生存率较高。
种族和家族史似乎在年轻男性中 CaP 的发病率中起着重要作用。诊断时年龄较小与更好的结果相关，这表明在年轻人群中进行基于人群的筛查可能会提高高危人群的生存率。
