O'Callaghan Michael E, Shi Zumin, Kopsaftis Tina, Moretti Kim
Urology Unit, SA Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, SA, 5041, Australia.
South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), Adelaide, SA, Australia.
Int Urol Nephrol. 2017 Mar;49(3):449-455. doi: 10.1007/s11255-017-1508-z. Epub 2017 Jan 12.
To examine the survival effect of treatment delays from the time of confirmed diagnosis of prostate cancer to first treatment in an Australian population.
Three thousand one hundred and forty patients were identified from the South Australian Prostate Cancer Clinical Outcomes Collaborative database for analysis. Selected patients had dates recorded for both diagnosis and treatment. We examined the effect of treatment delay (the time from diagnosis to date of first treatment) on survival using Cox and competing risks regression and compared quartiles of delay across the cohort. Adjustment was made for age, PSA levels, treatment modality and Gleason score. Outcomes included overall survival (OS) and prostate cancer-specific mortality (PCSM).
Quartiles of delay were as follows (days)-Q1: 35, Q2: 86, Q3: 138.0, Q4: 264. Shorter delays were associated with hormonal treatment, high Gleason score and high PSA values. Measuring PCSM with Q2 as reference, age-adjusted associations were-Q1: sHR 4.37 (2.75-6.94), Q3: sHR 1.29 (0.73-2.28), Q4: sHR 1.55 (0.91-2.63). After additional adjustment for treatment type, Gleason score and PSA, Q1 remained at increased risk [sHR 2.46 (1.10-5.54)]. A similar trend was observed for OS. In analysis stratified by Gleason score, delays were not significantly associated with OS.
Factors associated with shorter delay in treatment include high Gleason score, high PSA and hormonal treatment. After adjustment for these variables, increased delays were not associated with OS or PCSM in this cohort. The nonlinear association of delay with risk may explain conflicting reports in the literature.
研究在澳大利亚人群中，从确诊前列腺癌到首次治疗的治疗延迟对生存的影响。
从南澳大利亚前列腺癌临床结局协作数据库中确定3140例患者进行分析。选定的患者记录了诊断和治疗日期。我们使用Cox模型和竞争风险回归分析治疗延迟（从诊断到首次治疗的时间）对生存的影响，并比较队列中延迟的四分位数。对年龄、前列腺特异性抗原（PSA）水平、治疗方式和 Gleason评分进行了调整。结局包括总生存期（OS）和前列腺癌特异性死亡率（PCSM）。
延迟的四分位数如下（天）——第一四分位数（Q1）：35，第二四分位数（Q2）：86，第三四分位数（Q3）：138.0，第四四分位数（Q4）：264。较短的延迟与激素治疗、高Gleason评分和高PSA值相关。以Q2为参照测量PCSM，年龄调整后的关联为——Q1：标准化危险比（sHR）4.37（2.75 - 6.94），Q3：sHR 1.29（0.73 - 2.28），Q4：sHR 1.55（0.91 - 2.63）。在对治疗类型、Gleason评分和PSA进行额外调整后，Q1的风险仍然增加 [sHR 2.46（1.10 - 5.54）]。OS也观察到类似趋势。在按Gleason评分分层的分析中，延迟与OS无显著关联。
与治疗延迟较短相关的因素包括高Gleason评分、高PSA和激素治疗。在对这些变量进行调整后，该队列中延迟增加与OS或PCSM无关。延迟与风险的非线性关联可能解释了文献中相互矛盾的报道。
