Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Jpn J Clin Oncol. 2013 Aug;43(8):821-6. doi: 10.1093/jjco/hyt072. Epub 2013 May 31.
The aim of the study was to characterize trends in indications for and oncological outcomes of radical prostatectomy after 2000.
Data from 1268 patients undergoing radical prostatectomy without neoadjuvant therapy between 2000 and 2009 at four urological centers in Japan were retrospectively reviewed. Changes in age at radical prostatectomy, prostate-specific antigen level, biopsy Gleason score, clinical T stage, D'Amico risk classification, organ-confined disease and tumor volume in surgical specimens were analyzed over time.
The median age at radical prostatectomy decreased from 68 years in 2000-2 to 65 years in 2009 (P < 0.001). Approximately 63.3% of patients were ≥65 years old, and 31.4% of patients were ≥70 years old during the whole study period. The median prostate-specific antigen level decreased from 8.61 ng/ml in 2000-2 to 6.90 ng/ml in 2009 (P < 0.001). The rate of organ-confined disease increased from 52.8% in 2000-2 to 72.5% in 2009 (P = 0.004). The median tumor volume decreased from 1.70 cc in 2000-2 to 1.28 cc in 2009 (P = 0.017). The proportion of biopsy Gleason score 7 increased from 40.6% in 2000-2 to 60.1% in 2009 (P < 0.001), and the proportion of the intermediate-risk group increased from 39.5% in 2000-2 to 59.5% in 2009 (P < 0.001).
Age at radical prostatectomy for men with localized prostate cancer was higher in Japan than in the USA or Europe. Prostate-specific antigen, non-organ-confined disease and tumor volume decreased during the study period, whereas Gleason score 7 and intermediate-risk disease increased during the study period. This information enables comparison of outcomes between various treatments, between various geographic regions and between various time periods.
本研究旨在描述 2000 年后根治性前列腺切除术适应证和肿瘤学结果的变化趋势。
回顾性分析了 2000 年至 2009 年在日本 4 个泌尿外科中心接受无新辅助治疗的根治性前列腺切除术的 1268 例患者的数据。分析了随时间推移的根治性前列腺切除术年龄、前列腺特异性抗原水平、活检 Gleason 评分、临床 T 分期、D'Amico 危险分层、器官局限性疾病和手术标本肿瘤体积的变化。
根治性前列腺切除术的中位年龄从 2000-2 年的 68 岁降至 2009 年的 65 岁（P<0.001）。在整个研究期间，约 63.3%的患者年龄≥65 岁，31.4%的患者年龄≥70 岁。前列腺特异性抗原水平中位数从 2000-2 年的 8.61ng/ml 降至 2009 年的 6.90ng/ml（P<0.001）。器官局限性疾病的比例从 2000-2 年的 52.8%增加到 2009 年的 72.5%（P=0.004）。肿瘤体积中位数从 2000-2 年的 1.70cc 降至 2009 年的 1.28cc（P=0.017）。活检 Gleason 评分 7 的比例从 2000-2 年的 40.6%增加到 2009 年的 60.1%（P<0.001），中间风险组的比例从 2000-2 年的 39.5%增加到 2009 年的 59.5%（P<0.001）。
与美国或欧洲相比，日本接受局限性前列腺癌根治性前列腺切除术的患者年龄更高。研究期间，前列腺特异性抗原、非器官局限性疾病和肿瘤体积减少，而 Gleason 评分 7 和中间风险疾病增加。这些信息使我们能够在不同治疗方法、不同地理区域和不同时间段之间比较结果。
