淋巴结转移前列腺癌患者行根治性前列腺切除术失败后的当代趋势和生存结局。
Contemporary Trends and Survival Outcomes After Aborted Radical Prostatectomy in Lymph Node Metastatic Prostate Cancer Patients.
机构信息
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Eur Urol Focus. 2019 May;5(3):381-388. doi: 10.1016/j.euf.2018.01.009. Epub 2018 Feb 1.
BACKGROUND
Aborted radical prostatectomy (aRP) in lymph node (LN) metastatic (pN1) prostate cancer (PCa) patients showed worse survival in European patients. Contemporary rates of aRP are unknown in North America.
OBJECTIVE
To examine the rate of aRP and its effect on cancer-specific mortality (CSM) in contemporary North American patients.
DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance Epidemiology and End Results database (2004-2014), we identified 3719 pN1 PCa patients.
INTERVENTION
RP.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Incidence proportion and median survival of LN metastatic PCa patients who underwent aRP versus completed RP (cRP). Cumulative incidence plots and competing-risks regression (CRR) models tested CSM and other-cause mortality rates according to aRP versus cRP. The effect of selected variables on CSM rate was graphically depicted using LOESS methodology. All analyses were repeated after propensity score matching.
RESULTS AND LIMITATIONS
Between 2004 and 2014, the rate of aRP decreased from 20.4% to 5.6% (p<0.001). Ten-year CSM rates were significantly higher after aRP (38.9% vs 21.6%) versus cRP (p<0.001). In multivariable CRR models, aRP yielded higher CSM (hazard ratio [HR]: 1.99) than cRP. A higher 5-yr CSM rate was recorded after aRP through the entire range of baseline prostate-specific antigen (PSA) values and in patients with up to nine LN metastases. After propensity score matching, aRP resulted in overall higher CSM (HR: 1.72). Higher CSM was recorded after aRP for PSA values up to 50ng/ml and in patients with up to seven LN metastases. Results were limited by a selection bias that applies to aRP patients.
CONCLUSIONS
Of contemporary North American patients, 5% are affected by aRP. It confers a significant survival disadvantage that applies to patients with baseline PSA values up to 50ng/ml and in those with up to seven LN metastases.
PATIENT SUMMARY
Radical prostatectomy should not be aborted in pN1 prostate cancer individuals.
背景
在患有淋巴结转移（pN1）前列腺癌（PCa）的欧洲患者中，中止根治性前列腺切除术（aRP）后的生存率更差。目前尚不清楚北美的当代 aRP 发生率。
目的
研究当代北美患者中 aRP 的发生率及其对癌症特异性死亡率（CSM）的影响。
设计、地点和参与者：在监测、流行病学和最终结果（SEER）数据库（2004-2014 年）中，我们确定了 3719 名 pN1 PCa 患者。
干预措施
RP。
观察终点和统计分析
接受 aRP 与完成 RP（cRP）的 LN 转移性 PCa 患者的发病率比例和中位生存。根据 aRP 与 cRP，绘制累积发病率图和竞争风险回归（CRR）模型，以测试 CSM 和其他原因死亡率。使用 LOESS 方法直观地描绘了选定变量对 CSM 率的影响。所有分析均在倾向评分匹配后重复。
结果和局限性
2004 年至 2014 年间，aRP 的比例从 20.4%下降至 5.6%（p<0.001）。与 cRP 相比，aRP 后 10 年 CSM 率显著升高（38.9%vs.21.6%，p<0.001）。在多变量 CRR 模型中，aRP 的 CSM 更高（风险比[HR]：1.99）。在整个前列腺特异性抗原（PSA）值范围和多达 9 个淋巴结转移的患者中，aRP 后记录的 5 年 CSM 率更高。在倾向评分匹配后，aRP 导致总体 CSM 更高（HR：1.72）。aRP 后 PSA 值高达 50ng/ml 及淋巴结转移多达 7 个的患者，CSM 更高。结果受到仅适用于 aRP 患者的选择偏差的限制。
结论
在当代北美患者中，5%的患者受到 aRP 的影响。这带来了显著的生存劣势，适用于 PSA 值高达 50ng/ml 及淋巴结转移多达 7 个的患者。
患者总结
pN1 前列腺癌患者不应该中止根治性前列腺切除术。
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