Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
Eur Urol Focus. 2018 Dec;4(6):834-841. doi: 10.1016/j.euf.2017.01.017. Epub 2017 Feb 11.
The use of primary androgen deprivation therapy (PADT) is common in elderly men with early-stage prostate cancer (PCa), despite the absence of guideline recommendations.
To examine survival patterns of octo- and nonagenarian men with organ-confined PCa exposed to PADT, to assess whether their life expectancy warrants androgen deprivation therapy use.
DESIGN, SETTING, AND PARTICIPANTS: In the Surveillance, Epidemiology, and End Results-Medicare-linked database, we identified 14 785 octo- and nonagenarian organ-confined PCa patients treated with PADT between 1991 and 2009.
The smoothed cumulative incidence method was used to examine 10-yr overall mortality, cancer-specific mortality (CSM), and other-cause mortality (OCM) rates. Multivariable Cox regression analyses focused on the combined effect of age and Charlson comorbidity index (CCI) after adjusting for different confounders.
Of all the deaths observed during the study period, 80% were due to non-cancer causes and 20% were due to PCa. The 10-yr overall survival (OS) rate in the overall population was 15.4%. The 10-yr OS rates ranged from 19.9% in patients aged 80-84 yr to 3.1% in those aged ≥90 yr. Similarly, the 10-yr OS rates ranged from 18.7% in patients with CCI=0 to 11.5% in those with CCI≥2. The 10-yr OCM rate in the overall population was 68.2%. The 10-yr OCM rates ranged from 64.6% in patients aged 80-84 yr to 77.2% in patients aged ≥90 yr. Similarly, the 10-yr OCM rates ranged from 62.1% in patients with CCI=0 to 75.2% in those with CCI≥2. The 10-yr CSM rate in the overall population was 16.4%. The 10-yr CSM rates ranged from 15.5% in patients aged 80-84 yr to 19.7% in those aged ≥90 yr, and from 19.2% in patients with CCI=0 to 13.3% in those with CCI≥2.
Of the elderly patients with organ-confined PCa exposed to PADT, only 15% survive at 10-yr follow-up. Mortality related to non-cancer causes is the leading cause of death in the same follow-up period. These figures question the rationale for PADT in elderly men with organ-confined PCa.
In this study, we looked at the survival patterns of octo- and nonagenarians treated with primary androgen deprivation therapy for organ-confined prostate cancer. We found that a small proportion of patients who received primary androgen deprivation therapy remain alive at 10-yr follow-up, and the leading cause of death was not attributable to prostate cancer.
尽管没有指南推荐，但是在患有早期前列腺癌的老年男性中，经常使用主要雄激素剥夺疗法（PADT）。
检查接受 PADT 治疗的 80 岁及 90 岁以上局限性前列腺癌患者的生存模式，评估他们的预期寿命是否需要进行雄激素剥夺治疗。
设计、地点和参与者：在监测、流行病学和最终结果-医疗保险相关数据库中，我们确定了 1991 年至 2009 年间接受 PADT 治疗的 14785 名 80 岁及 90 岁以上局限性前列腺癌患者。
使用平滑累积发生率法检查 10 年总体死亡率、癌症特异性死亡率（CSM）和其他原因死亡率（OCM）。多变量 Cox 回归分析集中于在调整了不同混杂因素后，年龄和 Charlson 合并症指数（CCI）的综合效应。
在研究期间观察到的所有死亡中，80%是由非癌症原因引起的，20%是由前列腺癌引起的。总体人群的 10 年总生存率（OS）为 15.4%。10 年 OS 率从 80-84 岁患者的 19.9%到≥90 岁患者的 3.1%不等。同样，10 年 OS 率从 CCI=0 的患者的 18.7%到 CCI≥2 的患者的 11.5%不等。总体人群的 10 年 OCM 率为 68.2%。10 年 OCM 率从 80-84 岁患者的 64.6%到≥90 岁患者的 77.2%不等。同样，10 年 OCM 率从 CCI=0 的患者的 62.1%到 CCI≥2 的患者的 75.2%不等。总体人群的 10 年 CSM 率为 16.4%。10 年 CSM 率从 80-84 岁患者的 15.5%到≥90 岁患者的 19.7%不等，CCI=0 的患者为 19.2%，CCI≥2 的患者为 13.3%不等。
在接受 PADT 治疗的患有局限性前列腺癌的老年患者中，只有 15%在 10 年随访时存活。非癌症相关原因导致的死亡是同一随访期间的主要死亡原因。这些数据对在患有局限性前列腺癌的老年男性中使用 PADT 的合理性提出了质疑。
在这项研究中，我们观察了接受主要雄激素剥夺疗法治疗局限性前列腺癌的 80 岁及 90 岁以上患者的生存模式。我们发现，接受主要雄激素剥夺疗法治疗的患者中，只有一小部分在 10 年随访时存活，而主要死亡原因并非前列腺癌。
