摘要目的 探讨前列腺癌根治术对75岁及以上老年前列腺癌患者总生存及肿瘤特异性生存的影响. 方法 回顾性分析2004-2016年美国国立癌症数据库(SEER)中前列腺癌患者的数据,根据年龄选择75岁及以上的局限性前列腺癌患者数据进行分析.共纳入行前列腺癌根治术患者3 648例,未手术患者17 899例.比较手术与非手术患者的总生存和前列腺癌特异性生存情况.结果 75～79岁的高危前列腺癌患者中,手术治疗组的总生存和前列腺癌特异生存优于非手术组(OR=1.49,95％CI:1.22～1.82,P＜0.01;OR=1.43,95％CI:1.09～2.04,P＜0.05). 75～79岁的低危和≥80岁的低、中、高危前列腺癌患者手术组的总生存较非手术组差(OR=0.54,95％CI:0.38～0.76,P＜0.01;OR =0.47,95％CI:0.34～0.66,P＜0.01;OR =0.58,95％CI:0.44～0.78,P＜0.01;OR =0.59,95％CI:0.51～0.68,P＜0.01).75～79岁低、中危及≥80岁中危患者手术组与非手术组的前列腺癌特异生存比较,差异无统计学意义(均P＞0.05). 结论 前列腺癌根治术的年龄限制应适当放宽;75～79岁的高危前列腺癌患者可考虑手术治疗,对75～79岁低、中危或≥80岁的前列腺癌患者不应推荐手术治疗.前列腺癌治疗决策的制定应对多方面因素进行考量.

abstractsObjective To investigate the effects of radical prostatectomy on the overall survival (OS)and tumor-specific survival in prostate cancer(PCa)patients aged 75 years and older.Methods Clinical data of patients aged 75 and older with localized PCa from Surveillance,Epidemiology,and End Results(SEER)Database from 2004 to 2016 were retrospectively analyzed.There were 17 899 cases of PCa undergoing radical prostatectomy and 3 648 cases of PCa without surgery in this study.The OS and prostate cancer-specific survival(PSS)were compared between the surgery group and the nonsurgery group.Results For 75-79-year-old patients with high-risk localized PCa,the OS and PSS in the surgery group were better than in the non-surgery group (OR =1.49,95 ％ CI:1.22 ～ 1.82,P ＜ 0.01;OR=1.43,95％CI:1.09～2.04,P＜0.05).For patients aged 75-79 years with low-risk PCa and patients aged 80 years and older with low-,middle-,or high-risk PCa,the OS was worse in the surgery group than in the non-surgery group(OR =0.54,95％CI:0.38～0.76,P＜0.01;OR =0.47,95％CI:0.34～0.66,P＜0.01;OR =0.58,95％CI:0.44～0.78,P＜0.01;OR =0.59,95％CI:0.51 ～0.68,P＜0.01).For patients aged 75-79 years with low-or medium-risk PCa and patients aged 80 years and older with medium-risk PCa,there was no statistical difference in PSS between the surgery and non-surgery groups(P＞0.05).Conclusions Age limits for prostatectomy should be extended as a result of increasing average life expectancy.Patients aged 75-79 years with high-risk PCa can be considered for surgical treatment,while it should not be recommended for patients aged 75-79 years with low-or medium-risk localized PCa or aged more than 80 years.Many factors should be considered in making treatment decisions for prostate cancer.