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PO.PS01.05 · 人群科学

美国卫生专业人员前瞻性队列中低危和有利中危前列腺癌的致死性进展风险

Lethal progression risks of low risk and favorable-intermediate risk prostate cancer in a prospective cohort of US health professionals

编号 2347 展板 13 时间 4/20 09:00–12:00 区域 Section 36 主讲 Isaac Allen, PhD
分会场 Epidemiology: Cancer Incidence, Mortality, Patterns, and Methodology
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作者与单位 Authors & Affiliations

Isaac Allen1, Jane Bailey Vaselkiv2, Hannah E. Guard2, Sinead Flanagan2, Hari Iyer3, Kevin Kensler4, Jaime E. Hart5, Mark A. Preston6, Andreas Pettersson7, Keyan Salari8, Edward L. Giovannucci9, Meir Stampfer10, Adam S. Kibel6, Lorelei A. Mucci2, Timothy Rebbeck1

1Dana-Farber Cancer Institute, Boston, MA,2Harvard T.H. Chan School of Public Health, Boston, MA,3Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,4Weill Cornell Medicine, New York, NY,5Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA,6Department of Urology, Brigham and Women's Hospital, Boston, MA,7Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,8Department of Urology, Massachusetts General Hospital, Boston, MA,9Professor of Nutrition & Epidem., Harvard TH Chan School of Public Health, Boston, MA,10Department of Epidemiology, Harvard T.H. Chan School Public Health, Boston, MA

摘要 Abstract

中文摘要
背景 低危（分级组 1，分期 ≤cT2a，PSA<10）或有利中危（分级组 1，分期 cT2b-cT2c 或 PSA 10-20，或分级组 2，分期 ≤cT2a 且 PSA<10）前列腺癌患者有进展为致死性疾病（前列腺癌死亡或转移，或接受激素治疗）的风险。我们在一个由低危/有利风险前列腺癌卫生专业人员组成的前瞻性队列中估计了 35 年致死性进展风险。 方法 我们对 2872 名男性从诊断（1986-2019）随访至致死性进展，删失于其他原因死亡或 2022 年 12 月。我们使用 Kaplan-Meier 技术估计 35 年累积发生率，并使用 Cox 模型评估按治疗、社会人口学、PSA、分期、分级组和生活方式划分的致死性进展风险。 结果 在中位随访 15.7 年（IQR：8.6 年）期间，我们观察到 260 例致死性进展。35 年累积致死性进展发生率为 16.7%（95% 置信区间（CI）：13.3-20.4%）。致死性进展风险在诊断时年龄较大（风险比（HR）：1.08，95% CI：1.06-1.10）和诊断时 PSA 较高（HR：1.08，95% CI：1.05-1.12）的患者中更高，而在接受根治性治疗（根治性前列腺切除术、放疗、近距离放射治疗或冷冻手术）（HR：0.34，95% CI：0.24-0.48）或有更健康诊断后生活方式（体力活动、BMI 和吸烟的联合测量值增加 1，评分 0-3——HR：0.74，95% CI：0.60-0.91）的患者中更低。 结论 在 35 年的随访中，我们观察到诊断时年龄较大或诊断时 PSA 较高的患者致死性进展风险更高，而接受根治性治疗或有更健康诊断后生活方式的患者风险更低。这些结果可为低危/有利中危前列腺癌的临床管理提供参考。
查看英文原文 English abstract
Background Low-risk (grade group 1, stage≤cT2a, PSA<10) or favorable-intermediate risk (grade group 1, stage cT2b-cT2c or PSA 10-20, or grade group 2, stage≤cT2a and PSA<10) prostate cancer patients are at risk of progressing to lethal disease (prostate cancer death or metastasis, or receipt of hormones). We estimated 35-year lethal progression risks in a prospective cohort of health professionals with low/favorable-risk prostate cancer. Methods We followed 2872 men from diagnosis (1986-2019) to lethal progression, censoring at other-cause death or December 2022. We estimated 35-year cumulative incidences using Kaplan-Meier techniques and assessed lethal progression risk by treatment, sociodemographics, PSA, stage, grade group, and lifestyle with Cox models. Results We saw 260 lethal progressions over a median follow-up of 15.7 years (IQR: 8.6 years). The 35-year cumulative lethal progression incidence was 16.7% (95% confidence interval (CI): 13.3 - 20.4%). Lethal progression risks were higher in patients older at diagnosis (Hazard Ratio (HR): 1.08, 95% CI: 1.06 - 1.10) and with higher PSA at diagnosis (HR: 1.08, 95% CI: 1.05 - 1.12), and were lower in patients that received curative-intent treatment (radical prostatectomy, radiotherapy, brachytherapy, or cryosurgery) (HR: 0.34, 95% CI: 0.24 - 0.48) or or had healthier post-diagnostic lifestyles (increase of 1 in joint measure of physical activity, BMI, and smoking, scored 0-3 - HR: 0.74, 95% CI: 0.60 - 0.91). Conclusion Over 35 years of follow-up, we saw higher lethal progression risks in patients older at diagnosis or with higher PSA at diagnosis, and lower risks in patients that had curative-intent treatment or with healthier post-diagnosis lifestyles. These results may inform clinical management of low/favorable-intermediate risk prostate cancer.
利益披露 Disclosure
I. Allen, None.. J. E. Hart, None.. M. A. Preston, None.. A. Pettersson, None.. K. Salari, None.. M. Stampfer, None.. A. S. Kibel, None. L. A. Mucci, Convergent Therapuetics Other, Equity. Unrelated to this work. T. Rebbeck, None.

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