Chen Yushui, Fan Gen, Wu Yinyu, Wang Yu, Cai Songzhi, Li Yang, Tang Tielong
Department of Urology/School of Clinical Medicine, North Sichuan Medical College/Affiliated Hospital of North Sichuan Medical College, No. 1, South Maoyuan Road, Shunqing District, Nanchong City, 63700, Sichuan Province, China.
Int Urol Nephrol. 2025 Apr 8. doi: 10.1007/s11255-025-04489-z.
The association between different surgical methods combined with radiotherapy and the prognosis of patients with prostate cancer is still unclear. We retrospectively analyzed and compared the prognosis of TURP combined with radiotherapy and RP combined with radiotherapy for prostate cancer based on the SEER database.
We reviewed the SEER database for patients diagnosed with prostate cancer from 2010 to 2015. After propensity score matching, we performed IPTW on the data and performed a survival analysis on the data. KM curve and Cox survival analysis were used to report the association between different surgical methods combined with chemotherapy and the prognosis of prostate cancer patients. Subgroup analysis was used to report the consistency and stability of the results between different patient characteristics.
A total of 11,782 patients with prostate cancer were included in this study, Among them, there were 1758 cases (6.52%) in the TURP group and 10,024 cases (92.97%) in the RP group. A total of 928 patients were included in the study after PSM. Cox regression after PSM and IPTW showed that the prognosis of patients in the TURP group combined with radiotherapy was worse. Compared with the RP group combined with radiotherapy group, the TURP group combined with radiotherapy group had a 253% higher risk of death (HR = 3.53, 95%CI2.37-4.59, P < 0.001), and the prognosis of patients in the Gleason ≥ 8 subgroup was even worse. Compared with the Gleason ≤ 7 subgroup, the Gleason ≥ 8 subgroup had a 58% higher risk of death (HR = 158, 95% CI 1.43-1.59, P < 0.001). In addition, subgroup analysis and forest plots after PSM and IPTW showed that there was no significant difference between RP combined with radiotherapy and TURP combined with radiotherapy in the high-, medium-, and low-risk groups, the T staging subgroup without lymph node and distant metastasis, and the Gleason subgroup. It benefited more in patients aged 45-74 years.
RP combined with radiotherapy is associated with a better prognosis than TURP combined with radiotherapy, Patients in the Gleason ≤ 7 subgroup had a better prognosis than those in the Gleason ≥ 8 subgroup, and both surgical approaches combined with radiotherapy benefited more patients aged 45-74 years.
不同手术方法联合放疗与前列腺癌患者预后之间的关联仍不明确。我们基于监测、流行病学与最终结果（SEER）数据库，回顾性分析并比较了经尿道前列腺切除术（TURP）联合放疗与根治性前列腺切除术（RP）联合放疗治疗前列腺癌的预后。
我们查阅了SEER数据库中2010年至2015年被诊断为前列腺癌的患者资料。在进行倾向评分匹配后，我们对数据进行了逆概率加权处理（IPTW）并对数据进行生存分析。采用Kaplan-Meier（KM）曲线和Cox生存分析来报告不同手术方法联合化疗与前列腺癌患者预后之间的关联。采用亚组分析来报告不同患者特征之间结果的一致性和稳定性。
本研究共纳入11782例前列腺癌患者，其中TURP组1758例（6.52%），RP组10024例（92.97%）。经倾向评分匹配后，共928例患者纳入研究。倾向评分匹配和逆概率加权处理后的Cox回归分析显示，TURP联合放疗组患者的预后较差。与RP联合放疗组相比，TURP联合放疗组患者的死亡风险高253%（风险比[HR]=3.53，95%置信区间[CI]2.37 - 4.59，P<0.001），且在Gleason评分≥8亚组中患者的预后更差。与Gleason评分≤7亚组相比，Gleason评分≥8亚组患者的死亡风险高58%（HR = 1.58，95% CI 1.43 - 1.59，P<0.001）。此外，倾向评分匹配和逆概率加权处理后的亚组分析及森林图显示，在高、中、低风险组、无淋巴结及远处转移的T分期亚组以及Gleason亚组中，RP联合放疗与TURP联合放疗之间无显著差异。在45至74岁的患者中获益更多。
RP联合放疗比TURP联合放疗的预后更好，Gleason评分≤7亚组患者的预后优于Gleason评分≥8亚组患者，且两种手术方法联合放疗在45至74岁的患者中获益更多。
