Hong Xuwei, Cao Sizhe, Chi Zepai, Zhang Yuanfeng, Lin Tianxin, Zhang Yonghai
Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Urology, Shantou Central Hospital, Shantou, China.
Transl Androl Urol. 2023 Jan 30;12(1):58-70. doi: 10.21037/tau-22-818. Epub 2023 Jan 12.
Few reports have focused on the influencing factors of localized prostate cancer (PCa)-specific mortality so far. This study aimed to develop a competitive risk model for identifying the factors influencing the localized PCa mortality rate based on 135,310 subjects in the Surveillance, Epidemiology, and End Results (SEER) database.
We included 135,310 localized PCa male patients from SEER database 2004-2016 in this cohort study, and collected the baseline information of all patients, including age of diagnosis, race, marital status, socioeconomic status (SES), American Joint Committee on Cancer (AJCC) stage, prostate-specific antigen (PSA) Gleason score, and so on. The outcome was considered as PCa-specific mortality in this study. The end time of follow-up was November 2018. Independent risk factors were examined by multivariate Fine-Gray analysis. The results are shown by hazard ratio (HR) and 95% confidence interval (CI).
All patients were divided into three groups: died from localized PCa (n=1,400), died from other causes (n=16,996), and survived (n=116,914). The diagnostic age of 119,899 patients was ≥55 years. The multivariate Fine-Gray analysis indicated that age of diagnosis (55-70 years: HR =1.473, 95% CI: 1.124-1.930; >70 years: HR =2.528, 95% CI: 1.901-3.362), race (American India/Alaska Native, Asian/Pacific Islander: HR =0.653, 95% CI: 0.490-0.870), marital status (divorced: HR =1.433, 95% CI: 1.197-1.717; single: HR =1.463, 95% CI: 1.244-1.719; widowed: HR =1.485, 95% CI: 1.222-1.804), therapeutic method (radiotherapy: HR =1.500; 95% CI: 1.119-2.011), SES (4-10: HR =0.799, 95% CI: 0.664-0.961; ≥11: HR =0.670; 95% CI: 0.534-0.839), AJCC stage (HR =0.820, 95% CI: 0.715-0.940), level of PSA (HR: 1.002, 95% CI: 1.002-1.002) and Gleason score (HR: 2.226, 95% CI: 2.108-2.350) were associated with the risk of localized PCa mortality.
The study determined the influencing factors for mortality in patients with localized PCa through a competitive risk model. This finding may provide a reference for localized PCa patients: localized PCa patients who are older, divorced, widowed, single, have a radiotherapy, have a high PSA level, and Gleason score may be at high risk.
目前很少有报告关注局限性前列腺癌（PCa）特异性死亡率的影响因素。本研究旨在基于监测、流行病学和最终结果（SEER）数据库中的135310名受试者，开发一种竞争风险模型，以识别影响局限性PCa死亡率的因素。
在这项队列研究中，我们纳入了SEER数据库2004 - 2016年的135310名局限性PCa男性患者，并收集了所有患者的基线信息，包括诊断年龄、种族、婚姻状况、社会经济地位（SES）、美国癌症联合委员会（AJCC）分期、前列腺特异性抗原（PSA） Gleason评分等。本研究将结局视为PCa特异性死亡率。随访结束时间为2018年11月。通过多变量Fine - Gray分析检查独立危险因素。结果以风险比（HR）和95%置信区间（CI）表示。
所有患者分为三组：死于局限性PCa（n = 1400）、死于其他原因（n = 16996）和存活（n = 116914）。119899名患者的诊断年龄≥55岁。多变量Fine - Gray分析表明，诊断年龄（55 - 70岁：HR = 1.473，95% CI：1.124 - 1.930；>70岁：HR = 2.528，95% CI：1.9
