Patrikidou A, Loriot Y, Eymard J-C, Albiges L, Massard C, Ileana E, Di Palma M, Escudier B, Fizazi K
Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
Institut Jean-Godinot, Reims, France.
Prostate Cancer Prostatic Dis. 2014 Dec;17(4):348-52. doi: 10.1038/pcan.2014.35. Epub 2014 Oct 14.
During the last 30 years, there has been a major shift in initial staging in prostate cancer (CaP) in Western countries, with the incidence of metastases at diagnosis decreasing from over 50% in the 1970s to currently less than 10%. Yet, CaP is still the second cause of cancer death in men. We used two monthly curated databases of patients with castration-resistant prostate cancer (CRPC) to describe the natural history of patients dying of CaP in the modern era.
The outcome of 190 men with metastatic CRPC treated from 2008 to 2011 was studied. The characteristics of the patients who died from CaP (n = 113 patients, 61%) were analyzed.
All 113 patients who died of CaP were assessable for the presence of metastases at diagnosis. Sixty-three patients (56%) had detectable metastases at diagnosis: 67%, 11% and 43% had bone, visceral and lymph node metastases, respectively. The median time to CRPC was 16 months and median overall survival (OS) was 5.2 years.Among the patients with localized CaP at diagnosis (n = 50, 44%), 46% had T stage ⩾ 3 and 38% had a Gleason score ⩾ 8. Overall, 64% of patients were classified as having a high-risk CaP. Only 26% who died from CaP had a Gleason score ⩽ 6. Median OS was 8.8 years.
In the modern era, approximately half of the patients who die from CaP have metastases at diagnosis. The paradigm of progression from localized disease to metastasis and eventually death is only represented in the other half, although possible initial screening and staging errors ought to be taken into consideration. More efforts are needed to conduct trials in patients with newly diagnosed metastatic CaP.
在过去30年中，西方国家前列腺癌（CaP）的初始分期发生了重大变化，诊断时转移的发生率从20世纪70年代的超过50%降至目前的不到10%。然而，CaP仍然是男性癌症死亡的第二大原因。我们使用了两个每月整理的去势抵抗性前列腺癌（CRPC）患者数据库来描述现代死于CaP的患者的自然病史。
研究了2008年至2011年治疗的190例转移性CRPC男性患者的结局。分析了死于CaP的患者（n = 113例患者，61%）的特征。
所有113例死于CaP的患者在诊断时均可评估是否存在转移。63例患者（56%）在诊断时可检测到转移：分别有67%、11%和43%有骨、内脏和淋巴结转移。至CRPC的中位时间为16个月，中位总生存期（OS）为5.2年。在诊断时为局限性CaP的患者中（n = 50例，44%），46%的患者T分期⩾3，38%的患者Gleason评分⩾8。总体而言，64%的患者被归类为高危CaP。死于CaP的患者中只有26%的Gleason评分⩽6。中位OS为8.8年。
在现代，死于CaP的患者中约一半在诊断时有转移。从局限性疾病进展为转移并最终死亡的模式仅在另一半患者中体现，尽管应考虑到可能存在的初始筛查和分期错误。需要更多努力对新诊断的转移性CaP患者进行试验。
