Fowler J E, Terrell F L, Renfroe D L
Division of Urology, University of Mississippi Medical Center, Jackson, USA.
J Urol. 1996 Nov;156(5):1714-8.
We determined the impact of preexisting co-morbidities on survival of men with clinical stages T1b and T2NXM0 prostate cancer treated with surgery or radiation therapy.
A weighted co-morbidity score was determined for 276 consecutive men treated with surgery (138) or radiation therapy (138) at a Veterans Affairs medical center and was correlated with actuarial freedom from death due to co-morbid disease.
After a median potential followup of 7.0 years 91 patients (33%) died of co-morbid disease and 20 (7%) died of cancer related causes. There were highly significant correlations between actuarial survival and weighted co-morbidity (p < 0.000001), and the 10-year actuarial survivals in men with no or severe co-morbidities were 66 and 9%, respectively. Associations between patient age and co-morbidity score were highly significant (p < 0.0001). The age adjusted risk of co-morbid death was 5.7 times greater in men with severe compared to no co-morbidities. There were also significant correlations between actuarial survival and weighted co-morbidity among patients treated with surgery (p = 0.02) and radiation therapy (p = 0.0002). Patient age and severity of co-morbidities were significantly greater among men treated with radiation therapy compared to surgery, and age adjusted risk of co-morbid death among men with a co-morbidity score of 1 was 3.8 times greater among men treated with radiation therapy (p = 0.025).
Cancer related deaths are unusual within 5 to 10 years after surgery or radiation therapy in men with stages T1b and 2 prostate cancer. The risk of death during this interval is directly related to the severity of co-morbid conditions, which should be factored in an individual when assessing the advisability of therapeutic intervention. Since patient co-morbidities impact all cause survival, quantitative assessment of co-morbidities using validated instruments offers a method to control partially for the variabilities of health status among men receiving different treatments for localized prostate cancer.
我们确定了既往合并症对接受手术或放射治疗的临床分期为T1b和T2NXM0前列腺癌男性患者生存的影响。
为一家退伍军人事务医疗中心连续治疗的276名男性患者（138例接受手术，138例接受放射治疗）确定加权合并症评分，并将其与因合并症导致的精算无死亡生存率相关联。
中位潜在随访7.0年后，91例患者（33%）死于合并症，20例（7%）死于癌症相关原因。精算生存率与加权合并症之间存在高度显著相关性（p < 0.000001），无合并症或合并症严重的男性患者10年精算生存率分别为66%和9%。患者年龄与合并症评分之间的关联高度显著（p < 0.0001）。与无合并症的男性相比，合并症严重的男性因合并症死亡的年龄调整风险高5.7倍。在接受手术（p = 0.02）和放射治疗（p = 0.0002）的患者中，精算生存率与加权合并症之间也存在显著相关性。与手术治疗的男性相比，接受放射治疗的男性患者年龄和合并症严重程度显著更高，合并症评分为1的男性患者中，接受放射治疗的男性因合并症死亡的年龄调整风险高3.8倍（p = 0.025）。
对于T1b和T2期前列腺癌男性患者，手术或放射治疗后5至10年内，癌症相关死亡并不常见。此期间的死亡风险与合并症的严重程度直接相关，在评估治疗干预的 advisability时，应将其纳入个体考量因素。由于患者合并症会影响全因生存，使用经过验证的工具对合并症进行定量评估，为部分控制接受局限性前列腺癌不同治疗的男性健康状况差异提供了一种方法。
