高龄前列腺癌患者的临床特征及预后分析

The clinical characteristics and prognosis analysis of prostate cancer in elderly patients

目的分析年龄≥80岁的高龄前列腺癌患者临床特征、治疗方案和预后。方法回顾性分析2020年10月至2022年11月中国科学技术大学附属第一医院(安徽省立医院)收治的52例年龄≥80岁前列腺癌患者的临床资料,包括患者年龄、总前列腺特异性抗原(tPSA)、病理Gleason评分、临床分期、初始治疗方式、生存状况等。结果52例患者年龄(82.9±2.6)岁,Gleason评分8分以上占57.7%,Ⅲ、Ⅳ期占71.2%,骨转移占28.8%。治疗上,37例非转移性前列腺癌患者中,15例接受根治性手术,22例行内分泌治疗;15例转移性前列腺癌患者均接受内分泌治疗,其中2例联合放疗;随访12~41个月,非转移性患者中,根治性手术患者围术期未出现严重并发症,1例术后出现轻度尿失禁,3例生化复发,无死亡病例,其卡氏功能状态评分[90(70,90)分]显著高于非根治性手术患者[75(60,80)分],差异有统计学意义(P<0.05);转移性患者中,8例患者出现疾病进展,5例死亡。结论高龄前列腺癌患者具有高Gleason评分、临床分期晚、预后差等特征。对于一般情况良好的非转移性前列腺癌患者,根治性手术安全、有效,术后功能状态更佳。

Objective To investigate the clinical characteristics,treatment and prognosis of prostate cancer in elderly patients aged 80 years or older in our hospital.Methods Retrospective collection of clinical data from 52 patients aged≥80 years with prostate cancer admitted to the First Affiliated Hospital of University of Science and Technology of China from October 2020 to November 2022,including age,total prostate-specific antigen(tPSA),biopsy Gleason scores,clinical stage,initial treatment,survival and other outcomes.Results For all the 52 patients,the average age was(82.9±2.6)years old,57.7%had Gleason scores≥8,71.2%had stageⅢ-Ⅳ,and 28.8%had metastasis.In patients with non-metastatic prostate cancer,15 patients underwent radical prostatectomy and 22 received endocrine therapy.15 men with metastatic prostate cancer received endocrine therapy,and two of them combined with radiotherapy.During the follow-up of 12 to 41 months,no serious complications occurred in patients who underwent radical surgery,and mild urinary incontinence occurred in 1 case,biochemical recurrence occurred in 3 cases,no death was reported.The KPS functional status score of patients who underwent radical surgery[90(70,90)points]was significantly higher than that of patients who underwent non-radical surgery[75(60,80)points],and the difference was statistically significant(P<0.05).There were 8 cases progressed and 5 died in the patients with metastatic prostate cancer.Conclusions Elderly patients with prostate cancer have higher Gleason scores,later clinical stages,and poorer prognosis,who need active curative treatment.For non-metastatic elderly patients with prostate cancer with good condition,radical prostatectomy is a safe,effective treatment option,which might maintain and improve the functional status.