Clinical characteristics of prostate cancer in Japanese men in the eras before and after serum prostate-specific antigen testing
Clinical characteristics of prostate cancer in Japanese men in the eras before and after serum prostate-specific antigen testing
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DOI：
10.1111/j.1442-2042.2005.01113.x
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发表时间：
2005-07-01
影响因子：
2.6
通讯作者：
Miki, T
中科院分区：
文献类型：
--
作者：
Okihara, K;Nakanishi, H;Miki, T
背景：我们回顾了一大批经组织学证实的日本男性前列腺癌患者，以评估自1988年开始前列腺癌检测以来的三个不同前列腺癌治疗阶段的临床特征。方法：回顾1975-2002年间收治的1125例前列腺癌患者的年龄、主诉、临床分期、肿瘤分级、每个阶段的治疗方案和预后。我们将患者分类为：1975至1988年间在PSA前时代接受治疗的患者(n=182)，1988至1997年间PSA时代治疗的患者(n=301；PSA era 1期)和1998至2002年间PSA时代的患者(n=642；PSA era 2期)。结果：与PSA时代前相比，高分化腺癌的比例显著增加(24vs35%，P<；0.01)，临床器官受限疾病的比例(21vs43%，P<；0.01)。0.001)，以及在引入PSA检测后接受根治性前列腺切除术的患者比例(13%比20%，P<；0.01)。此外，在PSA时代之前(52%，95/182)和PSA时代第二阶段(42%，270/642，P<；0.05)之间，受试者年龄在70-79岁之间的比例有显著差异。在PSA前时期(78%)和PSA时期2期(10%，P<；0.001)，接受手术去势的患者比例也有显著差异。参与前列腺癌筛查的患者比例从3%(PSA时代前)增加到11%(PSA时代1期和PSA时代2期，P<；0.05)。在所有临床分期中，PSA前和后的原因特定生存率有显著差异(5年：A和B期分别为74%和94%，P<0.01；C期分别为54%和89%，P<；0.001；D期和D期分别为32%和53%；0.001)。结论：患者年龄(倾向于年轻患者)、癌症分期(倾向于早期)和组织学发现(倾向于有利结果)的迁移，加上治疗方案的改变，是导致日本前列腺癌患者在引入PSA检测后生存时间延长的原因之一。
Background: We retrospectively reviewed a large series of Japanese men with histologically proven prostate cancer to assess the clinical characteristics of the cancer in three different eras of prostate cancer management since prostate-specific antigen (PSA) testing started in 1988.Methods: The medical records of 1125 patients treated between 1975 and 2002 were reviewed with respect to age, chief complaints, clinical stage, tumor grade, treatment options at each stage, and prognosis. We classified the patients as follows: those treated in the pre-PSA era between 1975 and 1988 (n = 182), those treated in the PSA era between 1988 and 1997 (n = 301; PSA era phase 1) and the PSA era between 1998 and 2002 (n = 642; PSA era phase 2).Results: Compared with the pre-PSA era, there were significant increases in the proportion of well-differentiated adenocarcinoma with respect to the biopsy tumor grade (24 vs 35%, P < 0.01), in the proportion of clinically organ-confined disease (21 vs 43%, P < 0.001), and in the proportion of patients who underwent radical prostatectomy (13%vs 20%, P < 0.01) after PSA testing was introduced. In addition, there was a significant difference in the proportion of subjects who were 70-79 years of age between the pre-PSA era (52%, 95/182) and the PSA era phase 2 (42%, 270/642, P < 0.05). There was also a significant difference in the proportion of patients who underwent surgical castration between the pre-PSA era (78%) and PSA era phase 2 (10%, P < 0.001). The proportion of patients participating in prostate cancer screening increased from 3% (pre-PSA era) to 11% (PSA era phase 1 and PSA era phase 2, P < 0.05). In all clinical stages, there were significant differences between the pre- and post-PSA eras in cause-specific survival rates (5-year: 74 vs 94% in stages A and B, P < 0.01; 54 vs 89% in stage C, P < 0.001; 32 vs 53% in stage D, P < 0.001).Conclusions: Migrations in the age of patients (toward younger patients), the stage of the cancer (towards earlier stages) and the histological findings (toward favorable findings), in addition to changes in treatment options, have contributed to the prolonged survival of Japanese men with prostate cancer after the PSA testing was introduced.