Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
Cancer Med. 2023 Aug;12(16):16697-16706. doi: 10.1002/cam4.6292. Epub 2023 Jun 27.
The role of cytoreductive radical prostatectomy (cRP) for bone-metastatic prostate cancer (bmPCa) remains controversial. We aimed to figure out whether cRP and lymph node dissection (LND) can benefit bmPCa.
11,271 PCa patients with bone metastatic burden from 2010 to 2019 were identified using SEER-Medicare. Overall survival (OS) and cancer-specific survival (CSS) rates were visualized using Kaplan-Meier plots. Multivariable Cox regression analyses were constructed to examine the effects of cRP and LND on survival, after stratifying to age, prostate specific antigen (PSA), clinical stages, Gleason score, metastatic burden, radiotherapy, and chemotherapy status.
317 PCa patients underwent cRP and cRP was increasingly performed for bmPCa from 2010 (2.2%) to 2019 (3.0%) (p < 0.05). In multi analyses, cRP was predisposed to a better OS or CSS in patients with age < 75, PSA < 98 ng/mL, bone-only metastatic sites or patients not receiving chemotherapy (all p < 0.05). For the patients undergoing cRP, LND especially extended LND was associated with a better OS or CSS (all p < 0.05).
cRP might benefit OS or CSS in young patients with low PSA and bone-only metastatic sites not receiving chemotherapy. And a clear OS or CSS benefit of LND especially extended LND was observed in patients undergoing cRP.
对于骨转移前列腺癌（bmPCa），细胞减灭性前列腺切除术（cRP）的作用仍存在争议。我们旨在探讨 cRP 和淋巴结清扫（LND）是否对 bmPCa 有益。
使用 SEER-Medicare 确定了 2010 年至 2019 年间有骨转移负担的 11271 例前列腺癌患者。使用 Kaplan-Meier 图可视化总生存（OS）和癌症特异性生存（CSS）率。在分层考虑年龄、前列腺特异性抗原（PSA）、临床分期、Gleason 评分、转移负担、放疗和化疗状态后，构建多变量 Cox 回归分析以检查 cRP 和 LND 对生存的影响。
317 例前列腺癌患者接受了 cRP，并且从 2010 年（2.2%）到 2019 年（3.0%），cRP 越来越多地用于 bmPCa（p<0.05）。在多因素分析中，在年龄<75 岁、PSA<98ng/mL、仅有骨转移部位或未接受化疗的患者中，cRP 有利于更好的 OS 或 CSS（均 p<0.05）。对于接受 cRP 的患者，LND 尤其是广泛 LND 与更好的 OS 或 CSS 相关（均 p<0.05）。
在未接受化疗且 PSA 低和仅有骨转移部位的年轻患者中，cRP 可能有益于 OS 或 CSS。在接受 cRP 的患者中，LND 尤其是广泛 LND 明显有益于 OS 或 CSS。
