郑州市前列腺癌住院患者临床特征变化及预后因素的多中心回顾性研究

摘要

Objective To investigate the changes of clinical features and analysis of prognosis for inpatients with prostate cancer in Zhengzhou city.Methods A total of 789 patients with complete follow-up data of histological-proven prostate cancer diagnosed during period from 2005 to 2010 at 6 department of urology in Zhengzhou city were retrospectively collected.The average age of patients in this cohort was 71.5 years old(range 57-85 years old).According to the time of diagnosis,the patients were divided into two groups:early group (2005-2007) and contemporary group (2008-2010).The ages,smoke,drink,prostate volume,PSA,Gleason scores,tumor stages,bone metastasis,LUTS symptom,treatment options and medical payment were compared to determine whether the discrepancies were significant.The survival rate of patients was analyzed using Kaplan-Meier method.Prognostic factors were analyzed using the log-rank test and Cox proportional hazards model.Results The differences of ages,PSA levels,tumor stages,bone metastasis and treatment options between the two groups were significant (all P ＜0.05).The overall 3-year survival rate was 52.4％ and 75.6％ for early and contemporary groups respectively,and there was significant difference (P ＜ 0.05).Cox regression suggested that ages,Gleason scores,bone metastasis and treatment options were independent factors affecting the prognosis in early group,and Gleason scores,tumor stages,bone metastasis and treatment options were independent factors affecting the prognosis in contemporary group.Conclusions This study provides up-to-date evidence that the management of prostate cancer has made tremendous progress in Zhengzhou city,the 3-year overall survival rate of prostate cancer has significantly increased through promoting the levels of diagnosis and treatment.It is highly important of screening prostate cancer for old men and improving medical insurance policy to detect patients with earlier stage tumor.%目的 分析郑州市前列腺癌住院患者的临床特征变化及预后相关因素.方法 回顾性分析郑州市6家医院2005年至2010年间临床资料完整的789例经病理诊断为前列腺癌的住院患者,年龄57～85岁,平均71.5岁.根据就诊时间将患者分为早期组(2005年至2007年)和近期组(2008年至2010年),采集年龄、吸烟、饮酒、前列腺体积、前列腺特异抗原(PSA)、Gleason评分、肿瘤分期、骨转移、下尿路症候群(LUTS)症状、治疗方式等资料,比较组间是否有差异并分析影响患者预后的相关因素.结果 早期组与近期组相比,年龄、PSA水平、肿瘤分期、骨转移、治疗方式及医疗支付方式方面比较差异有统计学意义(P均＜0.05);早期组与近期组患者3年总体生存率分别为52.4％和75.6％,差异有统计学意义(P＜0.05).Cox回归多因素分析显示:年龄、骨转移及治疗方式是早期组患者的独立预后因素,肿瘤分期、骨转移、治疗方式是近期组患者的独立预后因素.结论 郑州市前列腺癌患者以中晚期居多,近年来诊疗方式变化较大,3年生存率明显提高,但与发达地区仍存在较大差距,进行PSA筛查并进一步完善医疗政策可使更多患者获益.