前列腺癌患者生存随访调查及预后影响因素研究

Survival follow-up survey and prognostic factors of prostate cancer patients

目的分析2000年1月至2018年12月重庆市有特殊病种医保的前列腺癌患者的生存情况,为前列腺癌的预后评价及防治提供参考依据。方法采用患者首次确诊恶性肿瘤的日期作为观察患者生存率的起点日期。本研究采用SPSS22.0统计软件进行统计分析,采用Kaplan-Meier法统计生存率和进行单因素分析,多因素分析采用COX回归模型进行分析;采用Graphpad Prism8.0绘制生存曲线;以P<0.05为差异有统计学意义。结果本研究一共收集1834例原发性前列腺癌患者,人口学特征为平均年龄(74.24±8.55)岁,中位年龄75岁,年龄最小47岁,最大98岁,其中大于等于75岁的患者人数最多,940例(占51.25%)。最终完成随访1486例(81.03%),其中1103例患者存活,生存比例占74.22%。研究对象的中位生存时间为78.54个月(95%CI:70.39-86.69),1、3、5年观察生存率分别为93.19%、74.79%、62.43%。单因素分析提示:不同年龄段、浸润深度(T)、有无阳性淋巴结(N)、是否远处转移(M)、临床分期、是否行根治术、不同分化程度的患者生存时间差异均有统计学意义;不同民族、婚姻状况、职业、住院时间的患者生存时间差异无统计学意义;多因素分析结果提示:有无阳性淋巴结(N)、是否远处转移(M)、是否行根治术是影响前列腺癌患者生存预后的独立危险因素,其中行根治术治疗是影响前列腺癌患者预后的保护因素。结论如何加强高风险人群的筛查,提高前列腺癌早期发现率以及提升整体诊治水平是今后前列腺癌防治工作的重点。

Objective To analyze the survival of prostate cancer patients who had municipal medical insurance for special diseases from January 2000 to December 2018 in Chongqing for providing reference for the prognosis evaluation,prevention and treatment of prostate cancer. Methods The date of the first diagnosis of malignant tumors was defined as the starting date for observing the survival rate of patients. SPSS22.0 statistical software was used for statistical analysis,Kaplan-Meier method was used for statistical survival rate and univariate analysis, COX regression model was used for multivariate analysis, Graphpad Prism8.0 was used to draw survival curve, and P < 0.05 was used as statistical significance.Results A total of 1834 cases of primary prostate cancer were collected in this study. The demographic characteristics were as follows: the average age was 74.24 + 8.55 years, the median age was 75 years, the youngest was 47 years, and the oldest was 98 years. Among them, 940 cases(51.25%) were older than 75 years. 1486 cases(81.03%) were followed up, of which1103 cases survived, accounting for 74.22%. The median survival time was 78.54 months(95% CI: 70.39-86.69), and the 1, 3 and 5-year survival rates were 93.19%, 74.79% and 62.43%, respectively. Univariate analysis showed that the survival time of patients with different age, depth of invasion(T), positive lymph node(N), distant metastasis(M), clinical stage, operation and differentiation had significant difference;the survival time of patients with different nationalities, marital status, occupation and length of stay was different. Multivariate analysis showed that the presence of positive lymph nodes(N), distant metastasis(M) and radical resection or not were independent risk factors for survival and prognosis of prostate cancer patients, and surgical treatment was the protective factor for prognosis of prostate cancer patients. Conclusions How to strengthen the screening of high-risk population, improve the early detection rate of prostate cancer, and improve the overall level of diagnosis and treatment are the focus of future prevention and treatment of prostate cancer.