Mirabeau-Beale Kristina, Chen Ming-Hui, D'Amico Anthony V
Harvard Radiation Oncology Program, Brigham and Woman's Hospital and Department of Radiation Oncology, Dana-Farber Cancer Institute, 75 Francis Street, Boston, MA 02115, USA.
Department of Statistics, University of Connecticut, Storrs, CT 06269, USA.
ISRN Oncol. 2014 Jan 30;2014:736163. doi: 10.1155/2014/736163. eCollection 2014.
Purpose. We evaluated the impact a prior cancer diagnosis had on the risk of prostate-cancer-specific mortality (PCSM) and all-cause mortality (ACM) in men with PC. Methods. Using the SEER data registry, 166,104 men (median age: 66) diagnosed with PC between 2004 and 2007 comprised the study cohort. Competing risks and Cox regression were used to evaluate whether a prior cancer diagnosis impacted the risk of PCSM and ACM adjusting for known prognostic factors PSA level, age at and year of diagnosis, race, and whether PC treatment was curative, noncurative, or active surveillance (AS)/watchful waiting (WW). Results. At a median followup of 2.75 years, 12,453 men died: 3,809 (30.6%) from PC. Men with a prior cancer were followed longer, had GS 8 to 10 PC more often, and underwent WW/AS more frequently (P < 0.001). Despite these differences that should increase the risk of PCSM, the adjusted risk of PCSM was significantly decreased (AHR: 0.66 (95% CI: (0.45, 0.97); P = 0.033), while the risk of ACM was increased (AHR: 2.92 (95% CI: 2.64, 3.23); P < 0.001) in men with a prior cancer suggesting that competing risks accounted for the reduction in the risk of PCSM. Conclusion. An assessment of the impact that a prior cancer has on life expectancy is needed at the time of PC diagnosis to determine whether curative treatment for unfavorable-risk PC versus AS is appropriate.
目的。我们评估了既往癌症诊断对前列腺癌患者前列腺癌特异性死亡率（PCSM）和全因死亡率（ACM）风险的影响。方法。利用监测、流行病学和最终结果（SEER）数据登记系统，2004年至2007年间确诊为前列腺癌的166,104名男性（中位年龄：66岁）组成了研究队列。采用竞争风险分析和Cox回归分析，在调整已知预后因素（前列腺特异性抗原（PSA）水平、诊断时年龄和年份、种族以及前列腺癌治疗是根治性、非根治性还是主动监测（AS）/密切观察等待（WW））的情况下，评估既往癌症诊断是否会影响PCSM和ACM风险。结果。在中位随访2.75年时，12,453名男性死亡：其中3809名（30.6%）死于前列腺癌。有既往癌症史的男性随访时间更长，更常患有Gleason评分8至10分的前列腺癌，且更频繁地接受WW/AS（P<0.001）。尽管这些差异本应增加PCSM风险，但既往有癌症史男性的PCSM调整风险显著降低（风险比（AHR）：0.66（95%置信区间（CI）：0.45，0.97）；P = 0.033），而ACM风险增加（AHR：2.92（95%CI：2.64，3.23）；P<0.001），这表明竞争风险是PCSM风险降低的原因。结论。在前列腺癌诊断时，需要评估既往癌症对预期寿命的影响，以确定对高危前列腺癌进行根治性治疗还是AS是否合适。
