Fang Kun, Song Pan, Zhang Jiahe, Yang Luchen, Liu Peiwen, Lu Ni, Dong Qiang
Department of Urology, West China Hospital of Sichuan University, Chengdu, China.
The Second Clinical Medical College of Lanzhou University, Lanzhou, China.
Front Surg. 2021 Oct 29;8:726534. doi: 10.3389/fsurg.2021.726534. eCollection 2021.
This study aimed to evaluate the survival outcomes of patients with bladder outlet obstruction (BOO) and metastatic prostate cancer (mPCa) after having a palliative transurethral resection of the prostate (pTURP) surgery. We identified patients with mPCa between 2004 and 2016 in the Surveillance, Epidemiology, and End Results (SEER) database. Patients who received pTURP and non-surgical therapy were identified. A propensity-score matching was introduced to balance the covariate. Kaplan-Meier analysis and COX regression were conducted to evaluate the overall survival (OS) and cancer-specific survival (CSS) outcomes. A total of 36,003 patients were identified; 2,823 of them were in the pTURP group and 33,180 were in the non-surgical group. The survival curves of the overall cohort showed that the pTURP group was associated with worse outcomes in both OS (HR: 1.12, 95% CI: 1.07-1.18, < 0.001) and CSS (HR: 1.08, 95% CI: 1.02-1.15, = 0.004) compared with the non-surgical group. The mean survival time in the overall cohort of the pTURP group was shorter than the non-surgical group in both OS [35.13 ± 1.53 vs. 40.44 ± 0.59 months] and CSS [48.8 ± 1.27 vs. 55.92 ± 0.43 months]. In the matched cohort, the pTURP group had significantly lower survival curves for both OS (HR: 1.25, 95% CI: 1.16-1.35, < 0.001) and CSS (HR: 1.23, 95% CI: 1.12-1.35, < 0.001) than the non-surgical group. pTURP significantly reduced the survival months of the patients (36.49 ± 0.94 vs. 45.52 ± 1.23 months in OS and 50.1 ± 1.49 vs. 61.28 ± 1.74 months in CSS). In the multivariate COX analysis, pTURP increased the risk of overall mortality (HR: 1.19, 95% CI: 1.09-1.31, < 0.001) and cancer-specific mortality CSS (HR: 1.23, 95% CI: 1.14-1.33, < 0.001) compared with the non-surgical group. For mPCa patients with BOO, pTURP could reduce OS and CSS while relieving the obstruction.
本研究旨在评估膀胱出口梗阻（BOO）合并转移性前列腺癌（mPCa）患者接受姑息性经尿道前列腺切除术（pTURP）后的生存结局。我们在监测、流行病学和最终结果（SEER）数据库中确定了2004年至2016年期间的mPCa患者。确定了接受pTURP和非手术治疗的患者。引入倾向评分匹配以平衡协变量。进行了Kaplan-Meier分析和COX回归以评估总生存（OS）和癌症特异性生存（CSS）结局。共确定了36,003例患者；其中2,823例在pTURP组，33,180例在非手术组。整个队列的生存曲线显示，与非手术组相比，pTURP组在OS（风险比：1.12，95%置信区间：1.07-1.18，<0.001）和CSS（风险比：1.08，95%置信区间：1.02-1.15，=0.004）方面的结局更差。pTURP组整个队列的平均生存时间在OS[35.13±1.53个月对40.44±0.59个月]和CSS[48.8±1.27个月对55.92±0.43个月]方面均短于非手术组。在匹配队列中，pTURP组在OS（风险比：1.25，95%置信区间：1.16-1.35，<0.001）和CSS（风险比：1.23，95%置信区间：1.12-1.35，<0.001）方面的生存曲线均显著低于非手术组。pTURP显著缩短了患者的生存月数（OS为36.49±0.94个月对45.52±1.23个月，CSS为50.1±1.49个月对61.28±1.74个月）。在多变量COX分析中，与非手术组相比，pTURP增加了总死亡率（风险比：1.19，95%置信区间：1.09-1.31，<0.001）和癌症特异性死亡率CSS（风险比：1.23，95%置信区间：1.14-1.33，<0.001）的风险。对于合并BOO的mPCa患者，pTURP在缓解梗阻的同时会降低OS和CSS。
