Department of Urology, Hebei Medical University Third Hospital, Shijiazhuang, China.
Eur Rev Med Pharmacol Sci. 2024 Mar;28(6):2372-2386. doi: 10.26355/eurrev_202403_35744.
Prostate cancer (PCa) is the most common malignant tumor in the male genitourinary system. Once PCa has metastasized, it is very difficult to cure. The purpose of this study was to investigate the prognostic risk factor analysis of patients with different prostate-specific antigen (PSA) levels in distant metastatic PCa. At the same time, we construct effective models for predicting the survival rate of prostate cancer patients.
Data on prostate cancer patients with the presence of distant metastases were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. PCa patients with distant metastases were categorized into two groups based on PSA levels, one with PSA <20 ng/mL and the other with PSA ≥20 ng/mL. Univariate and multivariate COX regression analyses were used to identify independent factors affecting the prognosis of the patients. A nomogram was constructed using the independent prognostic factors, and the results were evaluated using calibration curves, timeROC curves, and Kaplan-Meier curves.
In the PSA <20 ng/mL group, there were a total of 1,832 patients. COX regression analysis showed that age, marital status, N stage, grade, Gleason score, and medical household income inflation were independent prognostic factors for overall survival (OS) in patients. In addition, we found that age, marital status, N stage, bone metastasis, grade, and Gleason score were independent prognostic factors for cancer-specific survival (CSS) in patients. In the PSA ≥20 ng/mL group, there were a total of 5,314 patients. It was found that age, ethnicity, marital status, bone metastasis, first malignant primary indicator, grade, Gleason score, and medical household income inflation were patients' independent prognostic factors for OS. For CSS, we found that age, ethnicity, marital status, T stage, radiotherapy, bone metastasis, Gleason score, and Median household income inflation were independent prognostic factors. Constructing a nomogram can accurately predict the prognosis of this group of patients.
We found different independent prognostic factors for different PSA levels in patients with distant metastatic PCa. A new nomogram was constructed to predict OS and CSS in patients, which helps in clinical-assisted decision-making.
前列腺癌（PCa）是男性泌尿生殖系统中最常见的恶性肿瘤。一旦 PCa 发生转移，就很难治愈。本研究旨在探讨不同前列腺特异性抗原（PSA）水平的远处转移性 PCa 患者的预后风险因素分析。同时，构建预测前列腺癌患者生存率的有效模型。
从监测、流行病学和最终结果（SEER）数据库中获取有远处转移的前列腺癌患者数据。根据 PSA 水平将远处转移的 PCa 患者分为两组，一组 PSA<20ng/mL，另一组 PSA≥20ng/mL。采用单因素和多因素 COX 回归分析确定影响患者预后的独立因素。使用独立预后因素构建列线图，并通过校准曲线、时间 ROC 曲线和 Kaplan-Meier 曲线进行评估。
在 PSA<20ng/mL 组中，共有 1832 例患者。COX 回归分析显示，年龄、婚姻状况、N 分期、分级、Gleason 评分和医保家庭收入通胀是影响患者总生存期（OS）的独立预后因素。此外，我们发现年龄、婚姻状况、N 分期、骨转移、分级和 Gleason 评分是影响患者癌症特异性生存期（CSS）的独立预后因素。在 PSA≥20ng/mL 组中，共有 5314 例患者。结果发现，年龄、种族、婚姻状况、骨转移、第一恶性原发指标、分级、Gleason 评分和医保家庭收入通胀是影响 OS 的独立预后因素。对于 CSS，我们发现年龄、种族、婚姻状况、T 分期、放疗、骨转移、Gleason 评分和中等收入家庭收入通胀是独立的预后因素。构建列线图可以准确预测该组患者的预后。
我们发现不同 PSA 水平的远处转移性 PCa 患者存在不同的独立预后因素。构建了一个新的列线图来预测患者的 OS 和 CSS，有助于临床辅助决策。
