前列腺特异性抗原 U 型曲线与高级转移性前列腺腺癌前列腺癌特异性死亡率的关系。
The U Shape of Prostate-specific Antigen and Prostate Cancer-specific Mortality in High-grade Metastatic Prostate Adenocarcinoma.
机构信息
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
出版信息
Eur Urol Focus. 2020 Jan 15;6(1):53-62. doi: 10.1016/j.euf.2018.08.024. Epub 2018 Sep 11.
BACKGROUND
Accumulated evidence suggests that metastatic prostate cancer (mPCa) with a low prostate-specific antigen (PSA) level may be a unique entity. However, its clinical features and prognosis have not been fully evaluated.
OBJECTIVE
To investigate the clinical features of low-PSA mPCa and the impact of low PSA level on overall survival (OS) and PCa-specific mortality (PCSM) of mPCa.
DESIGN, SETTING, AND PARTICIPANTS: A total of 8479 mPCa patients were retrieved from the Surveillance, Epidemiology, and End Results program (2010-2015). The median follow-up was 18 mo.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Cox regression and Fine-Gray competing risk were used to calculate the hazard ratio (HR) and subdistribution hazard ratio (sHR) for OS and PCSM, respectively.
RESULTS AND LIMITATIONS
A higher rate of T4 stage disease (19.8%) and visceral metastasis (18.2%) and the shortest median OS (34 mo) were observed in mPCa patients with Gleason 8-10 and PSA ≤4ng/ml. In the Cox regression model, PSA ≤4ng/ml was a significant predictor of OS for Gleason 8-10 disease. The distribution of PCSM by PSA was U-shaped for Gleason score 8-10 (PSA 4.1-10ng/ml as the referent), with an adjusted sHR of 1.52 for PSA ≤4.0ng/ml (95% confidence interval: 1.17-1.96) versus 0.99 for PSA 10.1-20ng/ml and 1.35 for PSA >20ng/ml. In contrast, the distribution of PCSM by PSA was linear for Gleason 5-7. Sensitivity analyses showed similar results in Gleason 9-10 and Gleason 10 subgroup. The study is limited by its retrospective design.
CONCLUSIONS
Low PSA, high-grade mPCa has a higher proportion of T4 stage disease, visceral metastasis, and PCSM.
PATIENT SUMMARY
We found that 2.8% of high-grade metastatic prostate cancer has a prostate-specific antigen level ≤4ng/ml at diagnosis. This population has aggressive clinical features and a poor cancer-specific outcome. Our results highlighted this under-reported population, and the management of these patients warrants further research.
背景
越来越多的证据表明，前列腺特异性抗原（PSA）水平较低的转移性前列腺癌（mPCa）可能是一种独特的实体。然而，其临床特征和预后尚未得到充分评估。
目的
探讨低 PSA mPCa 的临床特征，以及 PSA 水平对 mPCa 总生存（OS）和前列腺癌特异性死亡率（PCSM）的影响。
设计、地点和参与者：从监测、流行病学和最终结果计划（2010-2015 年）中检索到 8479 例 mPCa 患者。中位随访时间为 18 个月。
观察指标和统计分析
使用 Cox 回归和 Fine-Gray 竞争风险分别计算 OS 和 PCSM 的风险比（HR）和亚分布风险比（sHR）。
结果和局限性
Gleason 8-10 且 PSA≤4ng/ml 的 mPCa 患者中，T4 期疾病（19.8%）和内脏转移（18.2%）发生率较高，中位 OS 最短（34 个月）。在 Cox 回归模型中，PSA≤4ng/ml 是 Gleason 8-10 疾病 OS 的显著预测因子。PSA 分布对 Gleason 评分 8-10 的 PCSM 呈 U 型（PSA 4.1-10ng/ml 为参照），PSA≤4.0ng/ml 的校正 sHR 为 1.52（95%置信区间：1.17-1.96），PSA 10.1-20ng/ml 的为 0.99，PSA>20ng/ml 的为 1.35。相比之下，PSA 分布对 Gleason 5-7 呈线性。敏感性分析显示 Gleason 9-10 和 Gleason 10 亚组有相似的结果。该研究受到其回顾性设计的限制。
结论
低 PSA、高级别 mPCa 具有更高比例的 T4 期疾病、内脏转移和 PCSM。
患者总结
我们发现，2.8%的高级别转移性前列腺癌在诊断时 PSA 水平≤4ng/ml。该人群具有侵袭性的临床特征和不良的癌症特异性结局。我们的研究结果强调了这一被低估的人群，这些患者的管理需要进一步研究。
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