1 673例前列腺癌的诊治和预后——上海单中心10年回顾分析

目的 总结复旦大学附属中山医院 10年间收治住院的前列腺癌患者的疾病特征和治疗方式变化,探讨前列腺癌的诊治、患者生存情况及其相关预后因素。 方法 回顾性分析2003年1月至2012年12月住院治疗的1 673例前列腺癌患者资料,包括初诊年龄、初诊前列腺特异性抗原(prostate specific antigen,PSA)、穿刺活检病理Gleason总评分、TNM分期、治疗方式及患者生存状态。将患者分为2组:2003—2007年(前5年)为第1组(n=542),2008—2012年(后5年)为第2组(n=1 131)。两组间比较,第2组比第1组病例数增加589例,增长109%。第2组较第1组平均年龄更低(70.8岁vs.71.9岁,P=0.003),初诊PSA<20 ng/mL占比更高(38.1% vs. 32.9%,P=0.004),穿刺活检病理Gleason总评分≥8占比更高(47.1% vs. 42.2%,P=0.012),局限性前列腺癌占比更高(58.9% vs. 45.0%,P<0.001),根治术所占比更高(33.7% vs.14.2%,P<0.001)。其中机器人辅助根治性前列腺切除术(robotic-assisted radical prostatectomy,RARP)在2008—2012年逐渐开展(0% vs.20.7%,P<0.001)。主要的转移靶器官均是骨。本文运用Kaplan-Meier方法对所有患者进行生存分析,并利用多因素Cox回归模型比较其预后因素。结果 患者中位随访时间为28个月(1～121个月)。初诊年龄(P<0.001)、初诊PSA水平(P=0.012)、穿刺活检病理Gleason总评分(P=0.006)和癌远处转移(P<0.001)均是患者总体生存的独立影响因素。结论 我院收治的前列腺癌患者的疾病特点在2003—2012年这10年间发生变化,初诊患者平均年龄降低,诊断局限性前列腺癌病例增加,但低分化肿瘤占比仍然增加。初诊年龄、初诊PSA水平、穿刺活检病理Gleason总评分和癌远处转移都是患者总体生存的独立影响因素。

A 10-year retrospective single-center analysis from Shanghai:survival,diagnosis and treatment of 1 673 patients with prostate cancer

Objective To report the survival outcomes for prostate cancer patients in a 10-year cohort who received various treatments, the changes of the baseline disease characteristics, and different treatment strategies in a single centre in Shanghai, China. Methods Between Jan., 2003 and Dec., 2012, 1 673 consecutive prostate cancer patients having underwent various surgical treatments were retrospectively collected at Zhongshan Hospital, Fudan University in Shanghai, China. All patients were divided into two groups based on time at diagnosis (Group 1: year 2003-2007; and Group 2: year 2008-2012). The number of patients in Group 2 was 1 131 cases, and was 542 in Group 1. Compared to patients from Group1, Group 2 had a lower mean age at diagnosis (71.9 y vs. 70.8 y, P=0.003), higher proportion of localised disease (45.0% vs. 58.9%, P<0.001), higher proportion of patients with PSA<20 ng/mL (32.9% vs. 38.1%, P=0.004), higher proportion of patients with biopsy Gleason-sum Score≥8 (42.2% vs. 47.1%, P=0.012), higher proportion of patients receiving radical prostatectomy (14.2% vs.33.7%, P<0.001) and also higher proportion of patients who chose robotic-assisted laparoscopy (0 vs. 20.7%, P<0.001). The main metastatic site was bone in both groups. Overall survivals were reported by primary disease features using Kaplan-Meier methods and hazard ratios were derived from multivariate cox models. Results Median follow-up time was 28 mo (range: 1-121 mo). Age (P<0.001), high PSA level at diagnosis (P=0.012), high biopsy Gleason-sum Score (P=0.006), and disease metastasis (P<0.001) were independent risk predictors for shorter overall survival. Conclusions Characteristics of primary disease and treatment strategies have significantly changed in Shanghai, China during the 10 years between 2003-2012. The main changes include more patients were diagnosed at an earlier age, earlier stage and with high-grade disease. Survival could be influenced by age at diagnosis, PSA level at diagnosis, biopsy Gleason-sum Score, and metastasis status.