美国偶发前列腺癌的特征。
Characteristics of incidental prostate cancer in the United States.
机构信息
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Department of Urology, Medical University of Graz, Graz, Austria.
出版信息
Prostate Cancer Prostatic Dis. 2024 Dec;27(4):709-714. doi: 10.1038/s41391-023-00742-7. Epub 2023 Oct 23.
BACKGROUND
Data regarding North-American incidental (cT1a/b) prostate cancer (PCa) patients is scarce. To address this, incidental PCa characteristics (age, PSA values at diagnosis, Gleason score [GS]), subsequent treatment and cancer-specific survival (CSS) rates were explored.
METHODS
Incidental PCa patients were identified within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Descriptive statistics, annual percentage changes (EAPC), Kaplan-Meier estimates, as well as Cox regression models were used. Bootstrapping technique was used to generate 95% confidence intervals for CSS at 6 years.
RESULTS
Of all 344,031 newly diagnosed non metastatic PCa patients, 5155 harbored incidental PCa. Annual rates of incidental PCa increased from 1.9% (2004) to 2.5 % (2015; p = 0.02). PSA values at diagnosis were 0-4 ng/ml in 48% vs. 4-10 ng/ml in 31% vs. > 10 ng/ml in 21%. Of all incidental PCa patients, 64% harbored GS 6 vs. 25% GS 7 vs. 11% GS ≥ 8. Of all incidental PCa patients, 47% were aged < 70, 35% were between 70 and 79 and 18% were ≥ 80 years. Subsequently, 71% underwent no local treatment (NLT) vs. 16% radical prostatectomy (RP) vs. 14% radiotherapy (RT). Proportions of patients with NLT increased from 65 to 81% (p = 0.0001) over the study period (2004-2015). CSS at six years ranged from 58% in GS ≥ 8 patients with NLT to 100% in patients who harbored GS 6 and underwent either RP or RT.
CONCLUSION
Incidental PCa in the United States is rare. Most incidental PCa patients are diagnosed in men aged less than 80 years of age. The majority of incidental PCa patients undergo NLT and enjoy excellent CSS.
背景
北美的偶发性（cT1a/b）前列腺癌（PCa）患者的数据很少。为了解决这个问题，研究了偶发性 PCa 的特征（年龄、诊断时的 PSA 值、Gleason 评分[GS]）、后续治疗和癌症特异性生存率（CSS）。
方法
在监测、流行病学和最终结果（SEER）数据库（2004-2015 年）中确定了偶发性 PCa 患者。使用描述性统计、年度百分比变化（EAPC）、Kaplan-Meier 估计以及 Cox 回归模型。使用自举技术生成 6 年 CSS 的 95%置信区间。
结果
在所有 344031 名新诊断的非转移性 PCa 患者中，有 5155 名患有偶发性 PCa。偶发性 PCa 的年发生率从 2004 年的 1.9%增加到 2015 年的 2.5%（p=0.02）。诊断时 PSA 值为 0-4ng/ml 的占 48%，4-10ng/ml 的占 31%，>10ng/ml 的占 21%。所有偶发性 PCa 患者中，GS 6 的占 64%，GS 7 的占 25%，GS≥8 的占 11%。所有偶发性 PCa 患者中，47%年龄<70 岁，35%年龄在 70-79 岁之间，18%年龄≥80 岁。随后，71%的患者未接受局部治疗（NLT），16%接受了根治性前列腺切除术（RP），14%接受了放疗（RT）。NLT 患者的比例从 2004 年至 2015 年从 65%增加到 81%（p=0.0001）。6 年 CSS 从 NLT 中 GS≥8 患者的 58%到 GS 6 且接受 RP 或 RT 的患者的 100%不等。
结论
美国的偶发性 PCa 很少见。大多数偶发性 PCa 患者诊断于年龄<80 岁的男性。大多数偶发性 PCa 患者接受 NLT 治疗，CSS 良好。
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