Gandaglia G, Karakiewicz P I, Abdollah F, Becker A, Roghmann F, Sammon J D, Kim S P, Perrotte P, Briganti A, Montorsi F, Trinh Q-D, Sun M
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
Eur J Surg Oncol. 2014 Dec;40(12):1706-15. doi: 10.1016/j.ejso.2014.05.001. Epub 2014 May 22.
To evaluate the effect of advancing age on cancer-specific mortality (CSM) after radical prostatectomy (RP).
Overall, 205,551 patients with PCa diagnosed between 1988 and 2009 within the Surveillance Epidemiology and End Results (SEER) database were included in the study. Patients were stratified according to age at diagnosis: ≤ 50, 51-60, 61-70, and ≥ 71 years. The 15-year cumulative incidence CSM rates were computed. Competing-risks regression models were performed to test the effect of age on CSM in the entire cohort, and for each grade (Gleason score 2-4, 5-7, and 8-10) and stage (pT2, pT3a, and pT3b) sub-cohorts.
Advancing age was associated with higher 15-year CSM rates (2.3 vs. 3.4 vs. 4.6 vs. 6.3% for patients aged ≤ 50 vs. 51-60 vs. 61-70 vs. ≥ 71 years, respectively; P < 0.001). In multivariable analyses, age at diagnosis was a significant predictor of CSM. This relationship was also observed in sub-analyses focusing on patients with Gleason score 5-7, and/or pT2 disease (all P ≤ 0.05). Conversely, age failed to reach the independent predictor status in men with Gleason score 2-4, 8-10, pT3a, and/or pT3b disease.
Advancing age increases the risk of CSM. However, when considering patients affected by more aggressive disease, age was not significantly associated with higher risk of dying from PCa. In high-risk patients, tumor characteristics rather than age should be considered when making treatment decisions.
评估年龄增长对根治性前列腺切除术（RP）后癌症特异性死亡率（CSM）的影响。
本研究纳入了监测、流行病学与最终结果（SEER）数据库中1988年至2009年间诊断为前列腺癌（PCa）的205,551例患者。根据诊断时的年龄将患者分层：≤50岁、51 - 60岁、61 - 70岁和≥71岁。计算15年累积发病率CSM率。采用竞争风险回归模型来检验年龄对整个队列以及各分级（Gleason评分2 - 4、5 - 7和8 - 10）和分期（pT2、pT3a和pT3b）亚组中CSM的影响。
年龄增长与15年CSM率升高相关（年龄≤50岁、51 - 60岁、61 - 70岁和≥71岁的患者，CSM率分别为2.3%、3.4%、4.6%和6.3%；P < 0.001）。在多变量分析中，诊断时年龄是CSM的显著预测因素。在针对Gleason评分5 - 7和/或pT2期疾病患者的亚分析中也观察到了这种关系（所有P≤0.05）。相反，在Gleason评分2 - 4、8 - 10、pT3a和/或pT3b期疾病的男性患者中，年龄未达到独立预测因素的地位。
年龄增长会增加CSM风险。然而，在考虑受侵袭性更强疾病影响的患者时，年龄与死于PCa的较高风险无显著关联。在高危患者中，制定治疗决策时应考虑肿瘤特征而非年龄。
