对于 70 岁以上的前列腺癌患者，与年龄相匹配的年轻患者相比，接受根治性前列腺切除术治疗的患者生化复发率更高。

Prostate cancer patients older than 70 years treated by radical prostatectomy have higher biochemical recurrence rate than their matched younger counterpart.

机构信息

Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.

出版信息

Prostate. 2013 Jun;73(8):897-903. doi: 10.1002/pros.22635. Epub 2012 Dec 31.

DOI:10.1002/pros.22635

PMID:23280623

Abstract

BACKGROUND

Consensus on prostate cancer (PCA) treatment in older men is currently lacking. We evaluated clinicopathological and oncological outcomes in patients >70-year-old treated with radical prostatectomy (RP).

METHODS

Clinicopathological and follow-up (FU) data for >70-year-old RP men (2000-2011) were recorded. Association between preoperative features, extraprostatic extension (EPE) and biochemical failure (bF), and postoperative features and bF, was explored. Patients >70-year-old were matched with younger (50- to 70-year-old) men with similar RP features to analyze the effect of age on bF.

RESULTS

Two hundred eighteen RP patients were >70-year-old. Clinical stage (cT) was T1 in 74.1%. Biopsy (Bx) Gleason score (GS) was 6 (35.8%), 7 (45.9%), and ≥8 (18.3%); RP GS was 6 (10.1%), 7 (63.3%), and ≥8 (26.6%). Median PSAD was 0.14 (range: 0.01-1.12). Pathologic stage (pT) was pT3 in 45.9%. bF occurred in 14.0%. Best preoperative predictive model for pT3 disease included D'Amico risk, number of Bx positive cores, PSAD, maximum % of PCA per core (P < 0.0001); cT, PSAD and primary Bx Gleason pattern best predicted bF preoperatively (P = 0.0031). Among postoperative features, high RP GS, positive margins, and pT3 were significantly associated with bF. Margin status and pT best predicted bF. Patients >70-year-old had 85% higher odds of bF compared to younger men (P = 0.036).

CONCLUSIONS

PCA detected in >70-year-old men shows adverse pathologic features. Failure rate is significantly higher in older than in matched younger patients.

摘要

背景

目前，对于老年男性前列腺癌（PCA）的治疗尚无共识。我们评估了行根治性前列腺切除术（RP）的>70 岁患者的临床病理和肿瘤学结局。

方法

记录了>70 岁行 RP 男性（2000-2011 年）的临床病理和随访（FU）数据。探讨了术前特征、前列腺外扩展（EPE）和生化失败（bF）之间的关系，以及术后特征和 bF 之间的关系。对>70 岁的患者与具有相似 RP 特征的年轻（50-70 岁）男性进行匹配，以分析年龄对 bF 的影响。

结果

218 例 RP 患者年龄>70 岁。临床分期（cT）为 T1 的占 74.1%。活检（Bx）Gleason 评分（GS）为 6（35.8%）、7（45.9%）和≥8（18.3%）；RP GS 为 6（10.1%）、7（63.3%）和≥8（26.6%）。中位 PSA 密度（PSAD）为 0.14（范围：0.01-1.12）。病理分期（pT）为 pT3 的占 45.9%。bF 发生率为 14.0%。预测 pT3 疾病的最佳术前预测模型包括 D'Amico 风险、Bx 阳性核心数、PSAD、每个核心中 PCA 的最大百分比（P<0.0001）；cT、PSAD 和原发性 Bx Gleason 模式最好地预测了术前 bF（P=0.0031）。在术后特征中，高 RP GS、阳性切缘和 pT3 与 bF 显著相关。切缘状态和 pT 最好地预测了 bF。与年轻男性相比，>70 岁的患者发生 bF 的可能性高 85%（P=0.036）。