Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
Regional Cancer Centre, Uppsala Örebro, Uppsala, Sweden; Cancer Epidemiology Group, Division of Cancer Studies, School of Medicine, King's College London, London, United Kingdom.
J Urol. 2017 Jan;197(1):61-66. doi: 10.1016/j.juro.2016.06.080. Epub 2016 Jun 17.
We compared clinical characteristics and cancer specific mortality in men diagnosed with prostate cancer before vs after age 50 years.
A total of 919 men 35 to 49 years old and 45,098 men 50 to 66 years old who were diagnosed with prostate cancer between 1998 and 2012 were identified in PCBaSe (Prostate Cancer data Base Sweden). Cancer specific mortality was compared among age groups (35 to 49, 50 to 59, 60 to 63 and 64 to 66 years) with and without adjusting for cancer characteristics, comorbidity and education in a multivariable Cox proportional hazards model.
Clinical cancer characteristics indicated that most nonmetastatic cancer in men younger than 50 years was detected after prostate specific antigen testing. The proportion of nonmetastatic vs metastatic disease at diagnosis was similar in all age groups. A strong association between younger age and poor prognosis was apparent in men in whom metastatic disease was diagnosed before age 50 to 55 years. The crude and adjusted HRs of cancer specific mortality were 1.41 (95% CI 1.12-1.79) and 1.28 (95% CI 1.01-1.62) in men diagnosed before age 50 and at age 50 to 59 years, respectively. In men with nonmetastatic disease crude cancer specific mortality increased with older age but adjusted cancer specific mortality was similar in all age groups.
Our findings suggest that an aggressive form of metastatic prostate cancer is particularly common in men younger than 50 to 55 years. Genetic studies and trials of intensified systemic treatment are warranted in this patient group.
我们比较了 50 岁前和 50 岁后诊断为前列腺癌的男性的临床特征和癌症特异性死亡率。
在 PCBaSe（瑞典前列腺癌数据库）中，共确定了 919 名 35 至 49 岁和 45098 名 50 至 66 岁之间诊断为前列腺癌的男性。在多变量 Cox 比例风险模型中，通过调整癌症特征、合并症和教育程度，比较了不同年龄组（35 至 49 岁、50 至 59 岁、60 至 63 岁和 64 至 66 岁）之间的癌症特异性死亡率。
临床癌症特征表明，50 岁以下男性的大多数非转移性癌症是在前列腺特异性抗原检测后发现的。在所有年龄组中，诊断时非转移性与转移性疾病的比例相似。在诊断为转移性疾病的男性中，年龄在 50 至 55 岁之前与预后不良之间存在明显的相关性。在诊断年龄小于 50 岁和 50 至 59 岁的男性中，癌症特异性死亡率的粗和调整后的 HR 分别为 1.41（95%CI 1.12-1.79）和 1.28（95%CI 1.01-1.62）。在非转移性疾病的男性中，癌症特异性死亡率随着年龄的增加而增加，但所有年龄组的调整后癌症特异性死亡率相似。
我们的研究结果表明，一种侵袭性的转移性前列腺癌在 50 至 55 岁以下的男性中尤为常见。在这一患者群体中，需要进行遗传研究和强化全身治疗试验。
