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[大学生论坛]:前列腺癌中的根治性前列腺切除术与观望式等待 - 29年追踪调查

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韬略 发表于 2019-1-4 02:04:28 | 显示全部楼层 |阅读模式
Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up前列腺癌中的根治性前列腺切除术与观望式等待 -  29年追踪调查
ABSTRACT 摘要
BACKGROUND
背景
Radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer, but evidence from randomized trials with long-term follow-up is sparse.
根治性前列腺切除术降低了患局限性前列腺癌的男性的死亡率,但长期跟踪的随机试验证据很少
METHODS
方法
We randomly assigned 695 men with localized prostate cancer to watchful waiting or radical prostatectomy from October 1989 through February 1999 and collected follow-up data through 2017. Cumulative incidence and relative risks with 95% confidence intervals for death from any cause, death from prostate cancer, and metastasis were estimated in intention-to-treat and per-protocol analyses, and numbers of years of life gained were estimated. We evaluated the prognostic value of histopathological measures with a Cox proportional-hazards model
1989年10月到1999年2月,我们随机分配了695名患有局限性前列腺癌的男性进行根治性前列腺切除术与观望式等待,并收集了到2017年的跟踪数据。累积发生率和相对风险,95%置信区间因其他原因死亡与前列腺癌死亡,在意向治疗和按方案分析中估计转移,并估计获得的生命年数。 我们用Cox比例风险模型评估了组织病理学测量的预后价值。

RESULTS
结果
By December 31, 2017, a total of 261 of the 347 men in the radical-prostatectomy group and 292 of the 348 men in the watchful-waiting group had died; 71 deaths in the radical-prostatectomy group and 110 in the watchful-waiting group were due to prostate cancer (relative risk, 0.55; 95% confidence interval [CI], 0.41 to 0.74; P<0.001; absolute difference in risk, 11.7 percentage points; 95% CI, 5.2 to 18.2). The number needed to treat to avert one death from any cause was 8.4. At 23 years, a mean of 2.9 extra years of life were gained with radical prostatectomy. Among the men who underwent radical prostatectomy, extracapsular extension was associated with a risk of death from prostate cancer that was 5 times as high as that among men without extracapsular extension, and a Gleason score higher than 7 was associated with a risk that was 10 times as high as that with a score of 6 or lower (scores range from 2 to 10, with higher scores indicating more aggressive cancer).
截至2017年12月31日,根治性前列腺切除术组347名男性中有261人死亡,而观望式等待组348名男性有292人死亡; 根治性前列腺切除术组中71人以及观察等待组中110人均死于前列腺癌(相对风险,0.55; 95%置信区间[CI],0.41至0.74; P <0.001;风险绝对差异,11.7% 分数; 95%CI,5.2至18.2)。 为避免其他原因导致死亡的治疗人数为8.4。 在第23年时,根治性前列腺切除术平均增加了2.9年寿命。 在接受根治性前列腺切除术的男性中,囊外扩展的男性死于前列腺癌的风险是无囊外扩展的男性的5倍,而格里森评分高于7的人死亡的风险是得分为6或以下的人的10倍(得分范围从2到10,得分越高表示癌症更严重)
CONCLUSIONS
结论
Men with clinically detected, localized prostate cancer and a long life expectancy benefited from radical prostatectomy, with a mean of 2.9 years of life gained. A high Gleason score and the presence of extracapsular extension in the radical prostatectomy specimens were highly predictive of death from prostate cancer. (Funded by the Swedish Cancer Society and others.)
根据临床检测,局限性前列腺癌和预期寿命长的男性受益于根治性前列腺切除术,平均获得了2.9年的生命。而格里森评分高的男性以及在根治性前列腺切除术中做了囊外扩展的男性死于前列腺癌的可能很高。 (由瑞典癌症协会和其他人资助。)

作者:
Anna Bill-Axelson, M.D., Ph.D., Lars Holmberg, M.D., Ph.D., Hans Garmo, Ph.D., Kimmo Taari, M.D., Ph.D., Christer Busch, M.D., Ph.D., Stig Nordling, M.D., Ph.D., Michael Häggman, M.D., Ph.D., Swen-Olof Andersson, M.D., Ph.D., Ove Andrén, M.D., Ph.D., Gunnar Steineck, M.D., Ph.D., Hans-Olov Adami, M.D., Ph.D., and Jan-Erik Johansson, M.D., Ph.D.
期刊名:The New England Journal of Medicine.发表时间:2018-12-13
N Engl J Med 2018; 379:2319-2329|December 13,2018|DOI: 10.1056/NEJMoa1807801



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