以梗阻性症状诊断的前列腺癌的发病率、种族差异及预后意义。
Incidence, racial differences, and prognostic significance of prostate carcinomas diagnosed with obstructive symptoms.
作者信息
Brawn P N, Johnson E H, Speights V O, Riggs M, Kuhl D, Abel P D, Lind M, Bell N
机构信息
Department of Pathology, Veterans Administration Medical Center, Ann Arbor, Michigan 48105.
出版信息
Cancer. 1994 Sep 1;74(5):1607-11. doi: 10.1002/1097-0142(19940901)74:5<1607::aid-cncr2820740518>3.0.co;2-f.
BACKGROUND
It is unknown how often prostate carcinomas are diagnosed as a result of urinary obstructive symptoms or whether prostate carcinomas diagnosed because of obstructive symptoms have a favorable or unfavorable prognosis. It is also unknown whether racial differences in obstructive symptoms could help explain why black men with prostate carcinoma are diagnosed with more advanced stages and grades of prostate carcinoma than are white men with prostate carcinoma.
METHOD
At a single Veterans Administration Medical Center, 478 consecutive cases of prostate carcinoma diagnosed between 1973 and 1985 were identified. The incidence of obstructive symptoms at diagnosis, racial differences in obstructive symptoms, and the survival of patients with and without obstructive symptoms, stratified by stage and grade, were determined. In addition, racial differences in the frequency of surgical intervention required to relieve the obstructive symptoms were determined.
RESULTS
All patients diagnosed with Stage A prostate carcinoma and most (82%) patients diagnosed with Stage C prostate carcinoma had obstructive symptoms. Those diagnosed with Stage B and Stage D prostate carcinomas had with similar frequencies (53% and 55%, respectively) of obstructive symptoms. Survival, stratified by stage and grade, was similar for men with and without obstructive symptoms. The incidences of obstructive symptoms and the frequency of surgical intervention to relieve the obstructive symptoms, stage for stage, were similar for white and black men.
CONCLUSION
Survival, stratified by stage and grade, is not affected adversely by obstructive symptoms. Neither racial differences in the incidence of obstructive symptoms nor the frequency with which obstructive symptoms require surgical correction explain why black men with CAP consistently are diagnosed more frequently with Stage D prostate carcinoma and less frequently with Stage A CAP than white men with CAP.
背景
尚不清楚因尿路梗阻症状而诊断出前列腺癌的频率，也不清楚因梗阻症状而诊断出的前列腺癌预后是好是坏。同样未知的是，梗阻症状的种族差异是否有助于解释为何前列腺癌黑人男性比白人男性被诊断出的前列腺癌分期和分级更高。
方法
在一家退伍军人管理局医疗中心，确定了1973年至1985年间连续诊断出的478例前列腺癌病例。确定了诊断时梗阻症状的发生率、梗阻症状的种族差异，以及有无梗阻症状患者按分期和分级分层的生存率。此外，还确定了缓解梗阻症状所需手术干预频率的种族差异。
结果
所有诊断为A期前列腺癌的患者以及大多数（82%）诊断为C期前列腺癌的患者都有梗阻症状。诊断为B期和D期前列腺癌的患者出现梗阻症状的频率相似（分别为53%和55%）。有无梗阻症状的男性按分期和分级分层的生存率相似。白人和黑人男性逐期的梗阻症状发生率以及缓解梗阻症状的手术干预频率相似。
结论
按分期和分级分层的生存率不受梗阻症状的不利影响。梗阻症状发生率的种族差异以及梗阻症状需要手术矫正的频率，都无法解释为何前列腺癌黑人男性比白人男性更常被诊断为D期前列腺癌，而较少被诊断为A期前列腺癌。
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