20-year outcomes following conservative management of clinically localized prostate cancer
20-year outcomes following conservative management of clinically localized prostate cancer
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DOI：
10.1001/jama.293.17.2095
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发表时间：
2005-05-04
影响因子：
120.7
通讯作者：
Fine, J
中科院分区：
文献类型：
--
作者：
Albertsen, PC;Hanley, JA;Fine, J
背景：临床上局限性前列腺癌患者的适当治疗尚不确定。最近的一项研究表明，前列腺癌确诊后存活超过15年的男性死亡率不断上升。目的根据诊断年龄和组织学结果，对诊断为临床局限性前列腺癌并单独接受观察或雄激素停药治疗的男性进行竞争风险分析，估计其20年生存率。设计、环境和患者：一项基于人群的回顾性队列研究，采用康涅狄格肿瘤登记处的数据，辅以医院记录和组织学回顾，研究对象为1971年1月1日至1984年12月31日诊断为临床局限性前列腺癌的767名男性，年龄在55岁至74岁之间。患者接受观察治疗或立即或延迟雄激素戒断治疗，中位观察时间为24年。主要结局指标：根据患者诊断时的年龄和肿瘤分级，前列腺癌或其他竞争性医疗条件导致死亡的概率。结果前15年随访期间前列腺癌死亡率为33 / 1000人-年（95%置信区间[CI]， 28-38）， 15年随访后为18 / 1000人-年（95% Cl, 10-29）。在调整肿瘤组织学差异后，这两个随访期的死亡率无统计学差异（比率比，1.1;95% Cl, 0.6-1.9）。在20年的随访期间，患有低级别前列腺癌的男性死于前列腺癌的风险最小（Gleason评分为2- 4,6例死亡/ 1000人年；95% Cl, 2-11）。患有高级别前列腺癌的男性在诊断后10年内死于前列腺癌的概率很高（Gleason评分为8-10，每1000人年死亡121例；95% Cl, 90156）。Gleason评分为5或6的男性患前列腺癌死亡的风险中等。结论前列腺癌的年死亡率在诊断后15年保持稳定，不支持局部低级别前列腺癌的积极治疗。
Context The appropriate therapy for men with clinically localized prostate cancer is uncertain. A recent study suggested an increasing prostate cancer mortality rate for men who are alive more than 15 years following diagnosis.Objective To estimate 20-year survival based on-a competing risk analysis of men who were diagnosed with clinically localized prostate cancer and treated with observation or androgen withdrawal therapy alone, stratified by age at diagnosis and histological findings.Design, Setting, and Patients A retrospective population-based cohort study using Connecticut Tumor Registry data supplemented by hospital record and histology review of 767 men aged 55 to 74 years with clinically localized prostate cancer diagnosed between January 1, 1971, and December 31, 1984. Patients were treated with either observation or immediate or delayed androgen withdrawal therapy, with a median observation of 24 years.Main Outcome Measures Probability of mortality from prostate cancer or other competing medical conditions, given a patient's age at diagnosis and tumor grade.Results The prostate cancer mortality rate was 33 per 1000 person-years during the first 15 years of follow-up (95% confidence interval [CI], 28-38) and 18 per 1000 person-years after 15 years of follow-up (95% Cl, 10-29). The mortality rates for these 2 follow-up periods were not statistically different, after adjusting for differences in tumor histology (rate ratio, 1.1; 95% Cl, 0.6-1.9). Men with low-grade prostate cancers have a minimal risk of dying from prostate cancer during 20 years of follow-up (Gleason score of 2-4, 6 deaths per 1000 person-years; 95% Cl, 2-11). Men with high-grade prostate cancers have a high probability of dying from prostate cancer within 10 years of diagnosis (Gleason score of 8-10, 121 deaths per 1000 person-years; 95% Cl, 90156). Men with Gleason score of 5 or 6 tumors have an intermediate risk of prostate cancer death.Conclusion The annual mortality rate from prostate cancer appears to remain stable after 15 years from diagnosis, which does not support aggressive treatment for localized low-grade prostate cancer.