Sun Weijie, Cai Yiduo, Feng Xiangnan, Fan Yi, Zhang Kun
First Clinical Medical College of Anhui Medical University, Hefei City, Anhui Province, China.
Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Ürümqi City, China.
Int Urol Nephrol. 2025 Apr 9. doi: 10.1007/s11255-025-04466-6.
Prostate cancer exhibits high incidence among males, yet the clinical utility of surgical intervention for non-metastatic disease remains controversial.
We extracted 290,749 cases from the SEER database (2010-2015) and categorized patients into a curative-directed surgery (CDS) group and a non-CDS group (surgery recommended but not performed). Propensity score matching (PSM) was applied to balance baseline characteristics. Survival analysis was conducted using Kaplan-Meier methods with stratified cumulative hazard curves, followed by multivariable Cox proportional hazards regression to estimate hazard ratios (HRs). Model selection was performed using the corrected Akaike Information Criterion (AICc).
After propensity score matching (PSM), each group consisted of 8,330 patients. The cumulative risk curves indicated no significant survival benefit in the CDS group compared to the non-CDS group (p = 0.34). Stratified analysis revealed age-dependent risk escalation, particularly pronounced in patients over 74 years old. Surgery was found to reduce the risk in stage T2 patients but had no such effect on stage T1 patients. Increased PSA levels and Gleason scores significantly worsened prognosis (p < 0.0001). Multivariate Cox regression analysis demonstrated that Gleason score is a critical factor influencing mortality risk, with high-risk Gleason scores (8-10) conferring a 6.31-fold (95% CI 6.23-8.58) increase in risk compared to low-risk scores (≤ 6), consistent with the trend observed in the cumulative risk curves.
For non-metastatic prostate cancer, surgical intervention may not confer a survival benefit, underscoring the need for cautious clinical decision-making. These findings warrant validation through prospective studies to elucidate the underlying mechanisms and refine treatment guidelines.
前列腺癌在男性中发病率较高，但对于非转移性疾病进行手术干预的临床效用仍存在争议。
我们从监测、流行病学与最终结果（SEER）数据库（2010 - 2015年）中提取了290,749例病例，并将患者分为根治性手术（CDS）组和非CDS组（建议手术但未进行手术）。应用倾向得分匹配（PSM）来平衡基线特征。使用Kaplan - Meier方法进行生存分析，并绘制分层累积风险曲线，随后进行多变量Cox比例风险回归以估计风险比（HRs）。使用校正的赤池信息准则（AICc）进行模型选择。
经过倾向得分匹配（PSM）后，每组有8330例患者。累积风险曲线表明，与非CDS组相比，CDS组在生存方面无显著益处（p = 0.34）。分层分析显示风险随年龄增加而升高，在74岁以上患者中尤为明显。发现手术可降低T2期患者的风险，但对T1期患者无此作用。前列腺特异抗原（PSA）水平升高和 Gleason评分显著恶化预后（p < 0.0001）。多变量Cox回归分析表明，Gleason评分是影响死亡风险的关键因素，高风险Gleason评分（8 - 10）与低风险评分（≤ 6）相比，风险增加6.31倍（95%可信区间6.23 - 8.58），这与累积风险曲线中观察到的趋势一致。
对于非转移性前列腺癌，手术干预可能无法带来生存益处，这突出了谨慎临床决策的必要性。这些发现需要通过前瞻性研究进行验证，以阐明潜在机制并完善治疗指南。
