Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Prostate. 2021 Nov;81(15):1149-1158. doi: 10.1002/pros.24209. Epub 2021 Aug 16.
BACKGROUND: To test the effect of urological primary cancers (bladder, kidney, testis, upper tract, penile, urethral) on overall mortality (OM) after secondary prostate cancer (PCa). METHODS: Within the Surveillance, Epidemiology and End Results (SEER) database, patients with urological primary cancers and concomitant secondary PCa (diagnosed 2004-2016) were identified and were matched in 1:4 fashion with primary PCa controls. OM was compared between secondary and primary PCa patients and stratified according to primary urological cancer type, as well as to time interval between primary urological cancer versus secondary PCa diagnoses. RESULTS: We identified 5,987 patients with primary urological and secondary PCa (bladder, n = 3,287; kidney, n = 2,127; testis, n = 391; upper tract, n = 125; penile, n = 47; urethral, n = 10) versus 531,732 primary PCa patients. Except for small proportions of Gleason grade group and age at diagnosis, PCa characteristics between secondary and primary PCa were comparable. Conversely, proportions of secondary PCa patients which received radical prostatectomy were smaller (29.0 vs. 33.5%), while no local treatment rates were higher (34.2 vs. 26.3%). After 1:4 matching, secondary PCa patients exhibited worse OM than primary PCa patients, except for primary testis cancer. Here, no OM differences were recorded. Finally, subgroup analyses showed that the survival disadvantage of secondary PCa patients decreased with longer time interval since primary cancer diagnosis. CONCLUSIONS: After detailed matching for PCa characteristics, secondary PCa patients exhibit worse survival, except for testis cancer patients. The survival disadvantage is attenuated, when secondary PCa diagnosis is made after longer time interval, since primary urological cancer diagnosis.
背景：检测泌尿系统原发性癌症（膀胱癌、肾癌、睾丸癌、上尿路癌、阴茎癌、尿道癌）对继发性前列腺癌（PCa）患者总死亡率（OM）的影响。
方法：通过监测、流行病学和最终结果（SEER）数据库，鉴定出患有泌尿系统原发性癌症且伴继发性 PCa（2004-2016 年诊断）的患者，并以 1:4 的比例与原发性 PCa 对照组相匹配。比较继发性和原发性 PCa 患者之间的 OM，并根据原发性泌尿系统癌症类型以及原发性泌尿系统癌症与继发性 PCa 诊断之间的时间间隔进行分层。
结果：共鉴定出 5987 例伴继发性和原发性 PCa（膀胱癌，n=3287；肾癌，n=2127；睾丸癌，n=391；上尿路癌，n=125；阴茎癌，n=47；尿道癌，n=10）和 531732 例原发性 PCa 患者。除了一小部分 Gleason 分级组和诊断时的年龄外，继发性和原发性 PCa 的 PCa 特征相当。相反，接受根治性前列腺切除术的继发性 PCa 患者比例较小（29.0%比 33.5%），而未接受局部治疗的患者比例较高（34.2%比 26.3%）。1:4 匹配后，除了原发性睾丸癌外，继发性 PCa 患者的 OM 较原发性 PCa 患者更差。最后，亚组分析表明，继发性 PCa 患者的生存劣势随着原发性癌症诊断后时间间隔的延长而降低。
结论：在详细匹配 PCa 特征后，除了睾丸癌患者外，继发性 PCa 患者的生存情况更差。当继发性 PCa 诊断发生在原发性泌尿系统癌症诊断后较长时间间隔时，这种生存劣势会减弱。
Eur Urol Focus. 2020-3-15
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