Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
Department of Urology, European Institute of Oncology, Milan, Italy.
World J Urol. 2020 Mar;38(3):725-732. doi: 10.1007/s00345-019-02869-6. Epub 2019 Jul 11.
To test the conditional survival that examined the effect of event-free survival on cancer-specific mortality after primary tumour excision (PTE) in patients with squamous cell carcinoma of the penis (SCCP).
Within the SEER database (1998-2015), 2282 stage I-III SCCP patients were identified. Conditional survival estimates were used to calculate cancer-specific mortality (CSM) after event-free survival intervals of 1, 2, 3, and 5 years. Multivariable Cox regression models predicted CSM according to event-free survival.
After PTE, 5-year CSM-free rate was 78.0% and increased to 84.6%, 88.1%, 92.0%, and 94.2% in patients who survived ≥ 1, ≥ 2, ≥ 3, and ≥ 5 years. After stratification according to tumour characteristics, 5-year CSM-free rates increased from 85.9 to 95.4%, 79.0 to 97.1%, 78.9 to 90.0%, and from 54.5 to 86.0% in those survived ≥ 5 years, respectively, in T1N0, T2N0, T3N0, and N1-2 patients. In multivariable analyses, T2N0 [hazard ratio (HR) 1.68; p value < 0.001], T3N0 (HR 1.94; p value 0.001), and N1-2 (HR 6.61; p value < 0.001) were independent predictors of higher CSM rate at baseline, relative to T1N0. A decrease in all HRs was assessed over time in patients who survived. Attrition due to CSM was highest in N1-2 cohort and lowest in T1N0.
Conditional survival models showed a direct relationship between event-free survival duration and subsequent CSM in SCCP patients. Even patients with non-organ-confined disease may achieve survival probabilities similar to those with organ-confined disease after at least 5 years of event-free survival since PTE.
检测无事件生存对原发肿瘤切除（PTE）后阴茎鳞癌（SCCP）患者癌症特异性死亡率的影响，以检验条件生存。
在 SEER 数据库（1998-2015 年）中，确定了 2282 例 I-III 期 SCCP 患者。使用条件生存估计来计算无事件生存间隔为 1、2、3 和 5 年后的癌症特异性死亡率（CSM）。多变量 Cox 回归模型根据无事件生存来预测 CSM。
PTE 后，5 年 CSM 无复发率为 78.0%，在无事件生存≥1、≥2、≥3 和≥5 年的患者中分别增加至 84.6%、88.1%、92.0%和 94.2%。根据肿瘤特征分层后，T1N0、T2N0、T3N0 和 N1-2 患者中，5 年 CSM 无复发率分别从 85.9%增加至 95.4%、79.0%增加至 97.1%、78.9%增加至 90.0%、54.5%增加至 86.0%。多变量分析显示，T2N0（HR 1.68；p 值<0.001）、T3N0（HR 1.94；p 值 0.001）和 N1-2（HR 6.61；p 值<0.001）是基线时 CSM 率较高的独立预测因素，与 T1N0 相比。在生存患者中，随着时间的推移，所有 HR 均呈下降趋势。在 N1-2 队列中，由于 CSM 导致的失访率最高，在 T1N0 队列中最低。
条件生存模型显示，无事件生存时间与 SCCP 患者随后的 CSM 之间存在直接关系。即使是非器官受限疾病患者，在 PTE 后至少 5 年无事件生存后，也可能获得与器官受限疾病相似的生存概率。
