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| 局限性前列腺癌患者药物去势治疗后的生存期 |
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| Survival Following Primary Androgen Deprivation Therapy Among Men With Localized Prostate Cancer |
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| Lu-Yao GL, Albertsen PC, Moore DF 2009/7/24 12:13:21 |
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| JAMA, 2009, |
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| View at Publisher |
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Context:
Despite a lack of data, increasing numbers of patients are receiving primary androgen deprivation therapy (PADT) as an alternative to surgery, radiation, or conservative management for the treatment of localized prostate cancer.
Objective:
To evaluate the association between PADT and survival in elderly men with localized prostate cancer.
Design, Setting, and Patients:
A population-based cohort study of 19 271 men aged 66 years or older receiving Medicare who did not receive definitive local therapy for clinical stage T1-T2 prostate cancer. These patients were diagnosed in 1992-2002 within predefined US geographical areas, with follow-up through December 31, 2006, for all-cause mortality and through December 31, 2004, for prostate cancer–specific mortality. Instrumental variable analysis was used to address potential biases associated with unmeasured confounding variables.
Main Outcome Measures:
Prostate cancer–specific survival and overall survival.
Results:
Among patients with localized prostate cancer (median age, 77 years), 7867 (41%) received PADT, and 11 404 were treated with conservative management, not including PADT. During the follow-up period, there were 1560 prostate cancer deaths and 11 045 deaths from all causes. Primary androgen deprivation therapy was associated with lower 10-year prostate cancer–specific survival (80.1% vs 82.6%; hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.03-1.33) and no increase in 10-year overall survival (30.2% vs 30.3%; HR, 1.00; 95% CI, 0.96-1.05) compared with conservative management. However, in a prespecified subset analysis, PADT use in men with poorly differentiated cancer was associated with improved prostate cancer–specific survival (59.8% vs 54.3%; HR, 0.84; 95% CI, 0.70-1.00; P=.049) but not overall survival (17.3% vs 15.3%; HR, 0.92; 95% CI, 0.84-1.01).
Conclusion:
Primary androgen deprivation therapy is not associated with improved survival among the majority of elderly men with localized prostate cancer when compared with conservative management. |
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 疾病资源中心
病例分析 [栏目介绍]
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
医学数据库
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