Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Urology, Munich, Germany.
Institute of Epidemiology and Medical Biometrics, University of Ulm, Ulm, Germany.
World J Urol. 2020 Dec;38(12):3091-3099. doi: 10.1007/s00345-020-03147-6. Epub 2020 Mar 11.
To determine whether fatal family history (FFH) or mode of inheritance in prostate cancer (PCa) has an impact on long-term outcomes following radical prostatectomy (RP).
1076 PCa patients after RP with at least one deceased first-degree relative with PCa were included and stratified by FFH (four subgroups: fraternal, paternal, multiple, and none) and by mode of inheritance (two subgroups: male to male, non-male to male). We compared clinicopathological characteristics between subgroups with Fisher's exact or Chi-square tests. Biochemical recurrence-free survival (BRFS) and cancer-specific survival (CSS) were analyzed using the method of Kaplan and Meier. Simple and multiple Cox regression with backward elimination were performed to select prognostic factors for BRFS and CSS.
Median age at surgery was 63.3 (range 35.9-79.4) years. The overall Kaplan-Meier estimated BRFS rate at 10 and 15 years was 65.6% and 57.0%, respectively. The overall Kaplan-Meier estimated CSS rate at 10 and 15 years was 98.1% and 95.7%, respectively. Neither FFH nor mode of inheritance were factors associated with worse BRFS. However, in multiple Cox regression, paternal FFH was an important prognostic factor for a better CSS (HR 0.19, CI 0.05-0.71, p = 0.014) compared to non-FFH.
FFH and mode of inheritance do not seem to be prognostic factors of worse long-term outcomes following RP. Rather, a paternal FFH was associated with a better CSS; however, the reasons remain unclear. Nevertheless, patients after RP and FFH could be reassured that their own PCa diagnosis is not associated with a worse long-term outcome.
确定前列腺癌（PCa）患者的家族性致死病史（FFH）或遗传模式是否会对根治性前列腺切除术（RP）后的长期预后产生影响。
共纳入 1076 例 RP 术后且至少有一位一级亲属死于 PCa 的 PCa 患者，并根据 FFH（四亚组：兄弟、父亲、多个、无）和遗传模式（两亚组：男传男、非男传男）进行分层。我们使用 Fisher 精确检验或卡方检验比较亚组间的临床病理特征。采用 Kaplan-Meier 法分析生化无复发生存率（BRFS）和癌症特异性生存率（CSS）。采用简单和多元 Cox 回归分析，使用逐步后退法筛选 BRFS 和 CSS 的预后因素。
中位手术年龄为 63.3 岁（范围 35.9-79.4）。10 年和 15 年的总体 Kaplan-Meier 估计 BRFS 率分别为 65.6%和 57.0%。10 年和 15 年的总体 Kaplan-Meier 估计 CSS 率分别为 98.1%和 95.7%。FFH 或遗传模式均不是 BRFS 预后不良的因素。然而，在多元 Cox 回归中，与无 FFH 相比，父亲 FFH 是 CSS 更好的重要预后因素（HR 0.19，CI 0.05-0.71，p=0.014）。
FFH 和遗传模式似乎不是 RP 后长期预后不良的预后因素。相反，父亲 FFH 与 CSS 更好相关；然而，原因尚不清楚。尽管如此，RP 术后且有 FFH 的患者可以放心，他们自己的 PCa 诊断与长期预后不良无关。
