目的: 分析前列腺癌(PCa)患者第二原发恶性肿瘤(SPM)的发病趋势,探讨前列腺癌患者发生SPM的危险因素及其对生存的影响。方法: 从SEER数据库(Surveillance, Epidemiology, and End Results Program database)中提取2004年至2016年前列腺癌患者作为研究队列,采用Joinpoint回归分析研究SPM的发病趋势。将患者分为仅患前列腺癌组(PCa组)和合并第二原发肿瘤组(PCa+1stPM组),使用倾向性评分匹配(PSM)方法以平衡基线特征。绘制Kaplan-Meier生存曲线并构建竞争风险模型比较患者总体生存(OS)和肿瘤特异性生存(CSS)情况。采用Logistic回归分析确定SPM的独立危险因素,Cox回归分析确定独立预后因素。通过构建列线图模型对前列腺癌合并SPM人群的预后进行预测。结果: 基于对SEER数据库大样本量研究队列数据的观察发现,PCa组和PCa+1stPM组的发病率在1992年之前呈上升趋势,随后呈波动下降趋势。多因素Logistic回归分析发现,化疗是PCa术后发生SPM的独立危险因素(OR=1.43, 95%CI 1.181~1.730,P<0.001);PCa患者合并SPM是OS较差的独立预后因素(HR=2.315, 95%CI 2.260~2.369, P<0.001)。与对照组相比,手术(HR=0.62, 95%CI 0.600 ~0.640, P<0.001)或放疗(HR=0.76, 95%CI 0.741~0.779,P<0.001)可给予患者更好的生存获益。基于大样本量队列构建的列线图模型对PCa合并SPM患者的预后表现出良好的预测效果。结论: PCa术后化疗会增加患者罹患SPM的风险,且不能改善预后。SPM是PCa患者较差OS的独立预后因素。PCa的手术治疗和放疗可有效降低SPM患病风险,并使患者生存获益。本研究构建的PCa合并SPM特异性列线图模型,可有效预测该人群预后。 |
[1] MILLER K D,NOGUEIRA L,DEVASIA T,et al.Cancer treatment and survivorship statistics,2022[J].CA Cancer J Clin,2022,72(5):409-436.
[2] SIEGEL R L,MILLER K D,FUCHS H E,et al.Cancer statistics,2021[J].CA Cancer J Clin,2021,71(1):7-33.
[3] 周金才,居峰,倪颖,等.前列腺健康指数在不同tPSA区间段诊断前列腺癌的临床价值研究[J].现代医学,2023,51(7):918-922.
[4] MOHIUDDIN J J,BAKER B R,CHEN R C.Radiotherapy for high-risk prostate cancer[J].Nat Rev Urol,2015,12(3):145-154.
[5] TEO M Y,RATHKOPF D E,KANTOFF P.Treatment of advanced prostate cancer[J].Annu Rev Med,2019,70:479-499.
[6] LITWIN M S,TAN H J.The diagnosis and treatment of prostate cancer:a review[J].JAMA,2017,317(24):2532-2542.
[7] VOGT A,SCHMID S,HEINIMANN K,et al.Multiple primary tumours:challenges and approaches,a review[J].ESMO Open,2017,2(2):e000172.
[8] TRAVIS L B,DEMARK W W,ALLAN J M,et al.Aetiology,genetics and prevention of secondary neoplasms in adult cancer survivors[J].Nat Rev Clin Oncol,2013,10(5):289-301.
[9] CHATTOPADHYAY S,ZHENG G,HEMMINKI O,et al.Prostate cancer survivors:risk and mortality in second primary cancers[J].Cancer Med,2018,7(11):5752-5759.
[10] CHEN T,FALLAH M,JANSEN L,et al.Distribution and risk of the second discordant primary cancers combined after a specific first primary cancer in German and Swedish cancer registries[J].Cancer Lett,2015,369(1):152-166.
[11] SEBESTA E M,ANDERSON C B.The surgical management of prostate cancer[J].Semin Oncol,2017,44(5):347-357.
[12] WOLFF R F,RYDER S,BOSSI A,et al.A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer[J].Eur J Cancer,2015,51(16):2345-2367.
[13] NAGAYA N,HORIE S.Endocrine therapy for prostate cancer[J].Clin Calcium,2018,28(11):1527-1533.
[14] BOULOS S,MAZHAR D.The evolving role of chemotherapy in prostate cancer[J].Future Oncol,2017,13(12):1091-1095.
[15] JAMES N D,DE BONO J S,SPEARS M R,et al.Abiraterone for prostate cancer not previously treated with hormone therapy[J].N Engl J Med,2017,377(4):338-351. |