Dell'Oglio P, Zaffuto E, Boehm K, Trudeau V, Larcher A, Tian Z, Moschini M, Shariat S F, Graefen M, Saad F, Capitanio U, Briganti A, Montorsi F, Karakiewicz P I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Eur J Surg Oncol. 2017 Aug;43(8):1581-1588. doi: 10.1016/j.ejso.2017.02.018. Epub 2017 Mar 10.
Radical prostatectomy (RP) is the gold standard for clinically localized prostate cancer (PCa) patients with life expectancy (LE) of at least 10 years. We examined long-term survival of men aged 80 years or older treated with RP and we attempted to identify criteria based on age and comorbidities that could predict survival of at least 10 years after RP, to identify those that might be considered for RP.
In Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, we identified 234 octo- and nonagenarians with clinical T1, T2 or T3 PCa treated with RP between 1991 and 2009. Kaplan-Meier analyses examined 10-year survival patterns. Multivariable Cox regression analyses focused on the combined effect of age and/or Charlson Comorbidity Index (CCI) after adjusting for different confounders.
The 10-year overall survival (OS) and cancer specific mortality (CSM) rates in the overall population were 51 and 9.9%. In individuals aged 80-81 years old, the 10-year OS was 62.4 vs. 39.6% in older patients (p = 0.001). Moreover, combination of age 80-81 with CCI = 0 yielded 10-year OS of 67.9 vs. 28.5% in older and sicker patients (p < 0.001). Age 80-81, absence of comorbidities and the combination of age 80-81 with CCI = 0, represented independent predictors of lower overall mortality (all p ≤ 0.01).
Two out of three individuals selected for RP aged 80-81 years and without comorbidities, fulfill the criterion of LE of 10 years or more. Therefore, elderly PCa individuals can be suitable for surgical management, if appropriately selected, based on LE criterion.
根治性前列腺切除术（RP）是预期寿命（LE）至少为10年的临床局限性前列腺癌（PCa）患者的金标准。我们研究了接受RP治疗的80岁及以上男性的长期生存率，并试图根据年龄和合并症确定可预测RP后至少10年生存率的标准，以确定那些可能适合接受RP治疗的患者。
在监测、流行病学和最终结果（SEER）与医疗保险关联数据库中，我们识别出1991年至2009年间接受RP治疗的234名八旬和九旬临床T1、T2或T3期PCa患者。Kaplan-Meier分析研究了10年生存模式。多变量Cox回归分析在调整不同混杂因素后，重点关注年龄和/或查尔森合并症指数（CCI）的综合影响。
总体人群的10年总生存率（OS）和癌症特异性死亡率（CSM）分别为51%和9.9%。在80 - 81岁的个体中，10年OS为62.4%，而老年患者为39.6%（p = 0.001）。此外，80 - 81岁且CCI = 0的患者，10年OS为67.9%，而年老且病情较重的患者为28.5%（p < 0.001）。80 - 81岁、无合并症以及80 - 81岁且CCI = 0的组合，是总体死亡率较低的独立预测因素（所有p≤0.01）。
在选择接受RP治疗的80 - 81岁且无合并症的患者中，三分之二符合10年或更长预期寿命的标准。因此，如果根据预期寿命标准进行适当选择，老年PCa患者可能适合手术治疗。
