Wu Kan, Tang Yongquan, Shao Yanxiang, Li Xiang
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.
Transl Androl Urol. 2021 Feb;10(2):879-887. doi: 10.21037/tau-20-1166.
Radical prostatectomy (RP) has heterogeneous effects on survival of patients with metastatic prostate cancer (mPCa). A reliable model to predict risk of cancer-specific mortality (CSM) and the potential benefit derived from RP is needed.
Patients diagnosed with mPCa were identified using the Surveillance, Epidemiology, and End Results database (2004-2015) and categorized in RP versus nonlocal treatment (NLT). Based on the Fine and Gray competing risks model in 8,463 NLT patients, a nomogram was created to predict CSM in mPCa patients. Decision tree analysis was then utilized for patient stratification. The effect of RP was evaluated among 3 different subgroups.
A total of 8,863 patients were identified for analysis. Four hundred (4.5%) patients received RP. The 5-year cumulative incidence of CSM was 52.4% for the entire patients. Based on nomogram scores, patients were sorted into three risk groups using decision tree analysis. In the low- and intermediate-risk group, RP was found to be significantly correlated with a 21.7% risk reduction of 5-year CSM, and 25.0% risk reduction of 5-year CSM, respectively, whereas RP was not associated with CSM in high-risk group (hazard ratio =0.748, 95% confidence interval 0.485-1.150; P=0.190).
We developed a novel nomogram and corresponding patient stratification predicting CSM in mPCa patients. A newly identified patient subgroup with low-, and intermediate-risk of CSM might benefit more from RP. These results should be further validated and improved by ongoing prospective trials.
根治性前列腺切除术（RP）对转移性前列腺癌（mPCa）患者的生存有不同影响。需要一个可靠的模型来预测癌症特异性死亡率（CSM）风险以及RP带来的潜在益处。
使用监测、流行病学和最终结果数据库（2004 - 2015年）识别诊断为mPCa的患者，并分为接受RP组和非局部治疗（NLT）组。基于8463例NLT患者的Fine和Gray竞争风险模型，创建了一个列线图来预测mPCa患者的CSM。然后利用决策树分析对患者进行分层。在3个不同亚组中评估RP的效果。
共纳入8863例患者进行分析。400例（4.5%）患者接受了RP。所有患者的5年CSM累积发生率为52.4%。根据列线图评分，使用决策树分析将患者分为三个风险组。在低风险和中风险组中，发现RP分别与5年CSM风险降低21.7%和25.0%显著相关，而在高风险组中RP与CSM无关（风险比 = 0.748，95%置信区间0.485 - 1.150；P = 0.190）。
我们开发了一种新的列线图和相应的患者分层方法来预测mPCa患者的CSM。新识别出的CSM低风险和中风险患者亚组可能从RP中获益更多。这些结果应通过正在进行的前瞻性试验进一步验证和完善。
