Department of Urology, Vita Salute University, San Raffaele Scientific Institute, Milan, Italy.
Eur Urol. 2013 Apr;63(4):693-701. doi: 10.1016/j.eururo.2012.08.054. Epub 2012 Sep 5.
Survival after surgical treatment using competing-risk analysis has been previously examined in patients with prostate cancer (PCa). However, the combined effect of age and comorbidities has not been assessed in patients with high-risk PCa who might have heterogeneous rates of competing mortality despite the presence of aggressive disease.
To examine the risk of 10-yr cancer-specific mortality (CSM) and other-cause mortality (OCM) according to clinical and pathologic characteristics of patients treated with radical prostatectomy (RP) for high-risk PCa.
DESIGN, SETTING, AND PARTICIPANTS: Within a multi-institutional cohort, 3828 men treated with RP for high-risk PCa (defined as the presence of at least one of these risk factors: prostate-specific antigen >20 ng/ml, biopsy Gleason score 8-10, clinical stage ≥ T3) were identified.
All patients underwent RP and pelvic lymph node dissection.
Competing-risk Poisson regression analyses were performed to simultaneously assess the 10-yr CSM and OCM rates after RP. The same analyses were also conducted after stratification of patients according to age at surgery, comorbidity status assessed by the Charlson Comorbidity Index (CCI), and number of risk factors (one vs two or more).
Overall, 229 patients (5.9%) died from PCa; 549 (14.3%) died from other causes. The 10-yr CSM and OCM rates ranged from 5.1% to 12.8% and from 4.3% to 37.4%, respectively. Age and CCI were the major determinants of OCM; their impact on CSM was minimal. OCM was the leading cause of death in all patient groups except in young men (≤ 59 yr) with no comorbidities, regardless of the number of risk factors (10-yr CSM and OCM 6.9-12.8% and 5.5-6.3%, respectively). The main limitation was the lack of patients managed conservatively.
Even in the context of high-risk PCa, long-term CSM after RP is modest and represents the leading cause of death only in young, healthy patients. Conversely, older and sicker patients with multiple risk factors are at the highest risk of dying from OCM while sharing very low CSM rates.
在前列腺癌（PCa）患者中，已经使用竞争风险分析来研究手术治疗后的生存率。然而，对于患有高危 PCa 的患者，尽管存在侵袭性疾病，但年龄和合并症的综合影响尚未得到评估，这些患者可能具有不同的竞争死亡率。
根据接受根治性前列腺切除术（RP）治疗的高危 PCa 患者的临床和病理特征，检查 10 年癌症特异性死亡率（CSM）和其他原因死亡率（OCM）的风险。
设计、设置和参与者：在一个多机构队列中，确定了 3828 名接受 RP 治疗的高危 PCa 患者（定义为存在以下至少一种危险因素之一：前列腺特异性抗原>20ng/ml、活检 Gleason 评分 8-10、临床分期≥T3）。
所有患者均接受 RP 和盆腔淋巴结清扫术。
使用竞争风险泊松回归分析同时评估 RP 后 10 年 CSM 和 OCM 率。还根据手术时的年龄、Charlson 合并症指数（CCI）评估的合并症状态以及危险因素的数量（一个与两个或更多）对患者进行分层后，进行了相同的分析。
总体而言，229 名患者（5.9%）死于 PCa；549 名（14.3%）死于其他原因。10 年 CSM 和 OCM 率范围分别为 5.1%至 12.8%和 4.3%至 37.4%。年龄和 CCI 是 OCM 的主要决定因素；它们对 CSM 的影响最小。除了没有合并症的年轻男性（≤59 岁）外，OCM 是所有患者群体死亡的主要原因，无论危险因素数量如何（10 年 CSM 和 OCM 分别为 6.9-12.8%和 5.5-6.3%）。主要限制是缺乏保守治疗的患者。
即使在高危 PCa 的情况下，RP 后长期 CSM 也适中，仅在年轻健康的患者中才是导致死亡的主要原因。相反，患有多种危险因素的年龄较大和身体较差的患者因 OCM 而死亡的风险最高，而 CSM 率则非常低。
