Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
Division of Urology, Durham Veterans Affairs Medical Center, Durham, North Carolina.
J Urol. 2020 Sep;204(3):511-517. doi: 10.1097/JU.0000000000001036. Epub 2020 Apr 3.
Men with biochemical recurrence after radical prostatectomy need information on competing risks of mortality to inform prognosis and guide treatment. We quantified the risk of prostate cancer metastasis and mortality, and other cause mortality across key clinical predictors.
We analyzed 1,225 men with biochemical recurrence after radical prostatectomy from 2001 to 2017 in the VA SEARCH database. Multivariable competing risks regression was used to identify predictors and quantify cumulative incidence of metastasis, prostate cancer specific mortality and other cause mortality. Recursive partitioning analysis was used to identify optimum variable cut points for prediction of prostate cancer specific mortality and other cause mortality.
During a median followup of 5.6 years after biochemical recurrence (IQR 2.7-9.1), 243 (20%) men died of other causes and 68 (6%) died of prostate cancer. Multivariable competing risks regression showed that high D'Amico tumor risk and prostate specific antigen doubling time at biochemical recurrence less than 9 months were associated with metastasis and prostate cancer specific mortality (p ≤0.001). Ten-year prostate cancer specific mortality was 14% and 9% for those with high risk tumors and prostate specific antigen doubling time less than 9 months, respectively. Advanced age and worse comorbidity were associated with other cause mortality (p ≤0.001). Ten-year other cause mortality was higher among men 70 years old or older with any Charlson comorbidity (1-3+) (40% to 49%) compared to those with none (20%). Recursive partitioning analysis identified optimal variable cut points for prediction of prostate cancer specific mortality and other cause mortality, with 10-year prostate cancer specific mortality ranging from 3% to 59% and 10-year other cause mortality ranging from 17% to 50% across risk subgroups.
Among men with biochemical recurrence after radical prostatectomy, there is significant heterogeneity in prognosis that can be explained by available clinical variables. Men in their 70s with any major comorbidity are 2 to 10 times more likely to die of other causes than of prostate cancer.
根治性前列腺切除术（radical prostatectomy）后出现生化复发的男性需要了解死亡率的竞争风险，以告知预后并指导治疗。我们量化了关键临床预测因素下前列腺癌转移和死亡以及其他原因死亡的风险。
我们分析了 2001 年至 2017 年间退伍军人事务部 SEARCH 数据库中 1225 例根治性前列腺切除术（radical prostatectomy）后出现生化复发的男性。使用多变量竞争风险回归来识别预测因子，并量化转移、前列腺癌特异性死亡和其他原因死亡的累积发生率。递归分区分析用于确定预测前列腺癌特异性死亡和其他原因死亡的最佳变量切点。
在生化复发后中位随访 5.6 年（IQR 2.7-9.1）期间，243（20%）名男性死于其他原因，68（6%）名男性死于前列腺癌。多变量竞争风险回归显示，高 D'Amico 肿瘤风险和生化复发时前列腺特异抗原倍增时间小于 9 个月与转移和前列腺癌特异性死亡相关（p≤0.001）。高风险肿瘤和前列腺特异抗原倍增时间小于 9 个月的患者，10 年前列腺癌特异性死亡率分别为 14%和 9%。年龄较大和合并症较差与其他原因死亡相关（p≤0.001）。70 岁及以上有任何 Charlson 合并症（1-3+）的男性 10 年其他原因死亡率（40%-49%）高于无合并症者（20%）。递归分区分析确定了预测前列腺癌特异性死亡和其他原因死亡的最佳变量切点，10 年前列腺癌特异性死亡率范围为 3%-59%，10 年其他原因死亡率范围为 17%-50%，风险亚组之间存在显著差异。
根治性前列腺切除术（radical prostatectomy）后生化复发的男性预后存在显著异质性，可用临床变量来解释。70 多岁且有任何主要合并症的男性死于其他原因的可能性是死于前列腺癌的 2-10 倍。
