老年高危前列腺癌患者接受确定性治疗的情况。

Receipt of definitive therapy in elderly patients with unfavorable-risk prostate cancer.

作者信息

Yang David D, Mahal Brandon A, Muralidhar Vinayak, Boldbaatar Ninjin, Labe Shelby A, Nezolosky Michelle D, Vastola Marie E, Beard Clair J, Martin Neil E, Mouw Kent W, Orio Peter F, King Martin T, Nguyen Paul L

机构信息

Harvard Medical School, Boston, Massachusetts.

Harvard Radiation Oncology Program, Boston, Massachusetts.

出版信息

Cancer. 2017 Dec 15;123(24):4832-4840. doi: 10.1002/cncr.30948. Epub 2017 Aug 22.

DOI:10.1002/cncr.30948

PMID:28832984

Abstract

BACKGROUND

Conservative management of aggressive prostate cancer in the elderly without definitive therapy has been associated with a 10-year prostate cancer-specific mortality of approximately 50%. The authors examined the prevalence of definitive therapy in elderly patients with intermediate-risk or high-risk disease.

METHODS

411,343 patients who were diagnosed from 2004 through 2012 with intermediate-risk or high-risk prostate cancer were identified in the National Cancer Database. Multivariable logistic regression adjusting for sociodemographic characteristics and comorbidity was used to examine the association between age and receipt of definitive therapy, defined as radical prostatectomy or radiotherapy, and of primary androgen deprivation therapy (ADT) among patients who did not receive definitive therapy.

RESULTS

In total, 87.1% of high-risk patients and 91.9% of intermediate-risk patients received definitive therapy. When stratified by age, 93.7%, 92.1%, 90.8%, 87.6%, 80.9%, and 55.2% of high-risk patients and 96.1%, 94.7%, 93.4%, 89.7%, 82.7%, and 62.8% of intermediate-risk patients ages <60, 60 to 64, 65 to 69, 70 to 74, 75 to 79, and ≥80 years received definitive therapy, respectively. For both high-risk and intermediate-risk patients, increasing age was significantly associated with a decreased likelihood of receiving definitive therapy overall (both P < .001) and a greater likelihood of receiving primary ADT among those who did not receive definitive therapy (both P < .001).

CONCLUSIONS

Older age was significantly associated with a decreased likelihood of receiving definitive therapy and an increased likelihood of receiving primary ADT in this national cohort of patients with intermediate-risk or high-risk prostate cancer. Notably, approximately 40% to 45% of patients aged ≥80 years did not receive definitive therapy. These findings are alarming given the dismal outcomes of conservatively managed unfavorable-risk prostate cancer. Cancer 2017;123:4832-40. © 2017 American Cancer Society.

摘要

背景

老年侵袭性前列腺癌患者若不接受确定性治疗，采用保守治疗时其10年前列腺癌特异性死亡率约为50%。作者研究了老年中危或高危前列腺癌患者接受确定性治疗的情况。

方法

在国家癌症数据库中识别出2004年至2012年期间诊断为中危或高危前列腺癌的411343例患者。采用多变量逻辑回归分析，对社会人口学特征和合并症进行校正，以研究年龄与接受确定性治疗（定义为根治性前列腺切除术或放疗）之间的关联，以及未接受确定性治疗的患者接受一线雄激素剥夺治疗（ADT）的情况。

结果

总体而言，87.1%的高危患者和91.9%的中危患者接受了确定性治疗。按年龄分层时，年龄＜60岁、60至64岁、65至69岁、70至74岁、75至79岁及≥80岁的高危患者中，分别有93.7%、92.1%、90.8%、87.6%、80.9%和55.2%接受了确定性治疗；中危患者中相应比例分别为96.1%、94.7%、93.4%、89.7%、82.7%和62.8%。对于高危和中危患者，年龄增长均与总体接受确定性治疗的可能性降低显著相关（P均＜0.001），且在未接受确定性治疗的患者中接受一线ADT的可能性更大（P均＜0.001）。