Guo Yadong, Mao Shiyu, Zhang Aihong, Zhang Junfeng, Wang Longsheng, Wang Ruiliang, Zhang Wentao, Zhang Ziwei, Wu Yuan, Cao Xuan, Yang Bin, Yao Xudong
Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China.
Front Oncol. 2019 Jul 19;9:638. doi: 10.3389/fonc.2019.00638. eCollection 2019.
This study compared survival of prostate cancer patients with low prostate specific antigen level (PSA ≤ 10 ng/ml) and high-grades of Gleason score (GS) of 8-10 with different treatment options (i.e., radical prostatectomy [RP], external beam radiotherapy [EBRT], or external beam radiotherapy with brachytherapy [EBRT+BT]). The Surveillance, Epidemiology and End Results (SEER) database data (2004-2013), and overall survival (OS) and prostate cancer-specific mortality (PCSM), were evaluated using the Cox proportional hazards regression model and Fine and Gray competing risk model. The SEER data contained 9,114 patients, 4,175 of whom received RP, 4,114 received EBRT, and 825 received EBRT+BT with a median follow-up duration of 47 months. RP patients had significantly better OS than patients with EBRT and EBRT+BT (adjusted HR [AHR]: 3.36, 95% CI: 2.43-4.64, < 0.001; AHR: 2.15, 95% CI: 1.32-3.48, = 0.002; respectively). There was no statistical difference in PCSM between RP and EBRT+BT (AHR: 1.31, 95% CI: 0.61-2.80, = 0.485), while EBRT had worse OS ( < 0.05). The subgroup analysis revealed that there was no statistical difference in prognosis of patients with age of >70 years old, or PSA levels of ≤ 2.5 ng/ml between RP and EBRT+BT ( > 0.05). RP patients with low PSA levels and high GS had better OS compared to either EBRT or EBRT+BT, while RP and EBRT+BT resulted in significantly lower PCSM, compared to EBRT. Moreover, EBRT+BT and RP were associated with similar survival of patients with age of > 70 years old, or PSA levels of ≤ 2.5 ng/ml.
本研究比较了前列腺特异性抗原水平较低（PSA≤10 ng/ml）且Gleason评分（GS）为8 - 10分的前列腺癌患者采用不同治疗方案（即根治性前列腺切除术[RP]、外照射放疗[EBRT]或外照射放疗联合近距离放疗[EBRT+BT]）后的生存率。利用监测、流行病学和最终结果（SEER）数据库数据（2004 - 2013年），并使用Cox比例风险回归模型和Fine及Gray竞争风险模型评估总生存期（OS）和前列腺癌特异性死亡率（PCSM）。SEER数据包含9114例患者，其中4175例接受了RP，4114例接受了EBRT，825例接受了EBRT+BT，中位随访时间为47个月。RP患者的OS显著优于EBRT和EBRT+BT患者（调整后风险比[AHR]：3.36，95%置信区间：2.43 - 4.64，P<0.001；AHR：2.15，95%置信区间：1.32 - 3.48，P = 0.002；分别）。RP和EBRT+BT之间的PCSM无统计学差异（AHR：1.31，95%置信区间：0.61 - 2.80，P = 0.485），而EBRT的OS较差（P<0.05）。亚组分析显示，年龄>70岁或PSA水平≤2.5 ng/ml的患者在RP和EBRT+BT之间的预后无统计学差异（P>0.05）。PSA水平低且GS高的RP患者与EBRT或EBRT+BT相比，OS更好，而与EBRT相比，RP和EBRT+BT导致的PCSM显著更低。此外，EBRT+BT和RP与年龄>70岁或PSA水平≤2.5 ng/ml的患者的生存率相似。
