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[大学生论坛]:患上前列腺癌,是接受根治性前列腺切除术还是等待观察?

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蓝色的大海 发表于 2019-1-4 11:42:17 | 显示全部楼层 |阅读模式
Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up
患上前列腺癌,是接受根治性前列腺切除术还是等待观察?——29年随访探究


本文出自:https://www.nejm.org/doi/full/10.1056/NEJMoa1807801
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.
期刊名称:The New England Journal of Medicine
发表时间:2018-12-13
N Engl J Med 2018; 379:2319-2329 | DOI: 10.1056/NEJMoa1807801




Abstract
摘要


Background
Radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer, but evidence from randomized trials with long-term follow-up is sparse.
背景
对于通过临床诊断发现患有局限性前列腺癌的男性患者来说,根治性前列腺切除术可降低他们的死亡率,但目前长期随访随机试验得到的佐证还很稀少。


Methods
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.
研究方法
1989年10月到1999年2月,我们将695名患有局限性前列腺癌的男性患者进行随机分组,对他们进行观察或进行根治性前列腺切除术,并且我们收集了随访数据,直到2017年才结束。我们在意向性治疗和合方案集的分析中采用累积发病率、因任何原因而死亡的累积相对风险度(95%置信区间)、前列腺癌死亡案例以及癌症转移案例进行评估,评估了患者存活的年数。此外,我们还用Cox比例风险模型评估了组织病理学预后价值。


Results
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).
研究结果
截至2017年12月31日,根治性前列腺切除术组347名患者和观察组348名患者共计分别有261名和292名患者死亡;分别有71例和110例死于前列腺癌(相对风险度0.55;95%置信区间[CI] 0.41 ~ 0.74; P <0.001;风险绝对差分11.7%;95%置信区间5.2 ~ 18.2)。在需要通过治疗以避免因任何原因而导致死亡的患者中,这个差分为8.4%。23年期间,患者如果接受根治性前列腺切除术,平均寿命增长了2.9年。另外在接受根治性前列腺切除术的男性中,如果是囊外延伸,死于前列腺癌的风险是无囊外延伸的5倍;如果患者格里森分数高于7,其死亡风险是分数在6及以下患者的10倍(分数范围为2到10,分数越高表示癌症的威胁性越强)。


Conclusions
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.)
结论
通过临床诊断检测到局限性前列腺癌的男性患者,如果预期寿命足够长,接受根治性前列腺切除术会取得好的效果,可延长平均2.9年的寿命。如果格里森分数较高,或者在根治性前列腺切除术标本中发现了囊外延伸的迹象,那么患者更有可能死于前列腺癌。
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