Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands.
J Geriatr Oncol. 2019 Mar;10(2):252-258. doi: 10.1016/j.jgo.2018.06.010. Epub 2018 Jul 7.
To examine the clinical features, applied treatments, and survival of older patients with prostate cancer compared with younger patients.
All patients diagnosed with prostate cancer between 2005 and 2015 in the Netherlands were identified from the nationwide population-based Netherlands Cancer Registry (NCR). Patient and tumour characteristics, as well as applied treatments, were described by age groups and prognostic risk groups. Relative survival rates were determined, including multivariable relative survival regression analyses. Additionally, to assess if age was associated with receiving curative treatment, a multivariable logistic regression analysis was performed.
In total, 48% of all patients were 70 years of age or older. Older patients had a higher prostate specific antigen (PSA) level, a higher Gleason score, as well as a higher disease stage at diagnosis. The 10-year relative survival decreased with increasing age, and after adjustment for disease stage, Gleason score, PSA level, and comorbidities, older patients had a worse survival rate. Older patients with intermediate- or high-risk disease appeared to be treated less often with curative intent compared with younger patients after adjustment for tumour stage, Gleason score, PSA level, and comorbidities. Older patients with intermediate/high risk prostate cancer treated with curative intent showed a 10-year relative survival rate similar to younger patients.
The survival of older patients was worse than younger patients. This might be due to suboptimal treatment, as older patients were less often treated with curative intent. Although the increased risk of treatment complications should be considered, age alone should not be a decisive factor when offering a treatment.
比较老年前列腺癌患者与年轻患者的临床特征、治疗方法和生存情况。
从荷兰全国基于人群的癌症登记处（NCR）中确定了 2005 年至 2015 年间所有被诊断为前列腺癌的患者。按年龄组和预后风险组描述患者和肿瘤特征以及应用的治疗方法。确定相对生存率，包括多变量相对生存回归分析。此外，为了评估年龄是否与接受根治性治疗有关，进行了多变量逻辑回归分析。
所有患者中有 48%的年龄在 70 岁或以上。老年患者的前列腺特异性抗原（PSA）水平更高、Gleason 评分更高、诊断时疾病分期更高。随着年龄的增长，10 年相对生存率下降，在调整疾病分期、Gleason 评分、PSA 水平和合并症后，老年患者的生存率更差。调整肿瘤分期、Gleason 评分、PSA 水平和合并症后，中危/高危疾病的老年患者似乎比年轻患者接受根治性治疗的比例更低。接受根治性治疗的中危/高危前列腺癌老年患者的 10 年相对生存率与年轻患者相似。
老年患者的生存情况比年轻患者差。这可能是由于治疗不当，老年患者接受根治性治疗的比例较低。尽管应考虑治疗并发症风险增加，但在提供治疗时，年龄不应是唯一决定性因素。
