據(jù)9月16日刊JAMA上的一則研究披露，對(duì)在不同時(shí)期被診斷的局灶性前列腺癌的保守療法的結(jié)果進(jìn)行比較后發(fā)現(xiàn),，與那些在1970年代至1980年代被診斷的人相比,，那些在1992-2002年期間被診斷的患者的總體存活率及前列腺癌特異性存活率都有所提高。
根據(jù)文章的背景資料：“在男性中,，前列腺癌是除皮膚癌之外的最常見的癌癥,，它也是美國(guó)第二位最常見的癌癥死亡原因。當(dāng)被診斷的時(shí)候,，大約有85%的前列腺癌是局限在前列腺內(nèi)的,，而對(duì)其的標(biāo)準(zhǔn)治療選項(xiàng)通常包括外科手術(shù)、放療或保守處理（即積極監(jiān)控或?qū)⒅委煏r(shí)間延遲到有必要對(duì)疾病的癥狀和體征進(jìn)行治療的時(shí)候）,。” “但是,，盡管保守療法是一種可能的合理治療選擇，但僅有大約10%的病人接受了保守療法,，這也許是因?yàn)槿藗儗?duì)其的了解以及當(dāng)代的有關(guān)這種療法的預(yù)計(jì)進(jìn)程和結(jié)果的數(shù)據(jù)有限所造成的,。” 文章的作者補(bǔ)充說(shuō)，由于缺乏可靠的當(dāng)代資訊使得患者以及他們的醫(yī)生對(duì)結(jié)果的預(yù)計(jì)以及做出有見地的治療決定變得困難,。
Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School, Piscataway, N.J.的Grace L. Lu-Yao, M.P.H., Ph.D.及其同僚分析了來(lái)自局灶性T1 或 T2前列腺癌患者的數(shù)據(jù),，并對(duì)保守處理局灶性前列腺癌的結(jié)果進(jìn)行了評(píng)估，這些前列腺癌的診斷時(shí)期與前列腺特殊抗原（PSA）的時(shí)期是相同的,。 這些基于人群的群組研究包括了其前列腺癌在診斷的時(shí)候（1992-2002 ）處于T1或T2期的1萬(wàn)4516名年齡在65歲或以上的男子,，這些人的癌癥在診斷之后的6個(gè)月之內(nèi)沒有接受過手術(shù)或放射治療。 這些患者所居住的地區(qū)具有監(jiān)控,、流行病學(xué)和終末結(jié)果（SEER）的計(jì)劃,。對(duì)這些患者的追蹤隨訪的中位（中點(diǎn)）數(shù)時(shí)間為8.3年（至2007年12月）?；颊咴谠\斷時(shí)的中位數(shù)年齡為78歲,。
研究人員發(fā)現(xiàn)，前列腺特異性的10年死亡率在分化良好的患者中為8.3%,；在中等分化的患者中為9.1%,；在分化不良的患者中為25.6%。 這些患者組的相應(yīng)的10年死于非前列腺癌的死亡率分別為59.8%、57.2%及56.5%,。
“在其它各種因素中,，與先前的報(bào)告相比，我們?cè)谘芯恐兴^察到的患者存活率的顯著改善可以由前置期的增加,、與PSA測(cè)試有關(guān)的過度診斷或等級(jí)遷移而得到部分的解釋,。 前列腺特異性抗原測(cè)試可在該疾病出現(xiàn)臨床癥兆之前6-13年便可被發(fā)現(xiàn)。 由于有這個(gè)前置時(shí)間的存在,，預(yù)計(jì)當(dāng)代的通過這種測(cè)試所發(fā)現(xiàn)的患者至少要多活6-13年的時(shí)間,。”(生物谷www.bioon.com)
Bioon推薦原始出處：
JAMA. 2009;302(11):1202-1209.
Outcomes of Localized Prostate Cancer Following Conservative Management
Grace L. Lu-Yao, MPH, PhD; Peter C. Albertsen, MD; Dirk F. Moore, PhD; Weichung Shih, PhD; Yong Lin, PhD; Robert S. DiPaola, MD; Michael J. Barry, MD; Anthony Zietman, MD; Michael O’Leary, MD, MPH; Elizabeth Walker-Corkery, MPH; Siu-Long Yao, MD
Context Most newly diagnosed prostate cancers are clinically localized, and major treatment options include surgery, radiation, or conservative management. Although conservative management can be a reasonable choice, there is little contemporary prostate-specific antigen (PSA)–era data on outcomes with this approach.
Objective To evaluate the outcomes of clinically localized prostate cancer managed without initial attempted curative therapy in the PSA era.
Design, Setting, and Participants A population-based cohort study of men aged 65 years or older when they were diagnosed (1992-2002) with stage T1 or T2 prostate cancer and whose cases were managed without surgery or radiation for 6 months after diagnosis. Living in areas covered by the Surveillance, Epidemiology, and End Results (SEER) program, the men were followed up for a median of 8.3 years (through December 31, 2007). Competing risk analyses were performed to assess outcomes.
Main Outcome Measures Ten-year overall survival, cancer-specific survival, and major cancer related interventions.
Results Among men who were a median age of 78 years at cancer diagnosis, 10-year prostate cancer-specific mortality was 8.3% (95% confidence interval [CI], 4.2%-12.8%) for men with well-differentiated tumors; 9.1% (95% CI, 8.3%-10.1%) for those with moderately differentiated tumors, and 25.6% (95% CI, 23.7%-28.3%) for those with poorly differentiated tumors. The corresponding 10-year risks of dying of competing causes were 59.8% (95% CI, 53.2%-67.8%), 57.2% (95% CI, 52.6%-63.9%), and 56.5% (95% CI, 53.6%-58.8%), respectively. Ten-year disease-specific mortality for men aged 66 to 74 years diagnosed with moderately differentiated disease was 60% to 74% lower than earlier studies: 6% (95% CI, 4%-8%) in the contemporary PSA era (1992-2002) compared with results of previous studies (15%-23%) in earlier eras (1949-1992). Improved survival was also observed in poorly differentiated disease. The use of chemotherapy (1.6%) or major interventions for spinal cord compression (0.9%) was uncommon.
Conclusions Results following conservative management of clinically localized prostate cancer diagnosed from 1992 through 2002 are better than outcomes among patients diagnosed in the 1970s and 1980s. This may be due, in part, to additional lead time, overdiagnosis related to PSA testing, grade migration, or advances in medical care.
