目的:分析前列腺癌(PCa)患者第二原发恶性肿瘤(SPM)的发病趋势,探讨前列腺癌患者发生SPM的危险因素及其对生存的影响.方法:从SEER数据库(Surveillance,Epidemiology,and End Results Program database)中提取2004年至2016年前列腺癌患者作为研究队列,采用Joinpoint回归分析研究SPM的发病趋势.将患者分为仅患前列腺癌组(PCa组)和合并第二原发肿瘤组(PCa+1stPM组),使用倾向性评分匹配(PSM)方法以平衡基线特征.绘制Kaplan-Meier生存曲线并构建竞争风险模型比较患者总体生存(OS)和肿瘤特异性生存(CSS)情况.采用Logistic回归分析确定SPM的独立危险因素,Cox回归分析确定独立预后因素.通过构建列线图模型对前列腺癌合并SPM人群的预后进行预测.结果:基于对SEER数据库大样本量研究队列数据的观察发现,PCa组和PCa+1stPM组的发病率在1992年之前呈上升趋势,随后呈波动下降趋势.多因素Logistic回归分析发现,化疗是PCa术后发生SPM的独立危险因素(OR=1.43,95％CI 1.181～1.730,P＜0.001);PCa 患者合并 SPM 是 OS 较差的独立预后因素(HR=2.315,95％CI 2.260～2.369,P＜0.001).与对照组相比,手术(HR=0.62,95％CI 0.600～0.640,P＜0.001)或放疗(HR=0.76,95％CI 0.741～0.779,P＜0.001)可给予患者更好的生存获益.基于大样本量队列构建的列线图模型对PCa合并SPM患者的预后表现出良好的预测效果.结论:PCa术后化疗会增加患者罹患SPM的风险,且不能改善预后.SPM是PCa患者较差OS的独立预后因素.PCa的手术治疗和放疗可有效降低SPM患病风险,并使患者生存获益.本研究构建的PCa合并SPM特异性列线图模型,可有效预测该人群预后.
Clinical features of secondary primary malignancies after prostate cancer and construction of survival nomogram:a retrospective study based on a SEER cohort
Objective:To analyze incidence trends of second primary malignancy(SPM)in patients with prostate cancer(PCa)and to evaluate the risk factors of developing SPM as well as the impact on survival in a population-based cohort.Methods:Joinpoint regression analysis was used to examine the incidence trends of SPM.Patients were selected and performed propensity score matching(PSM)to balance baseline characteristics.Kaplan-Meier curves and competition risk model were used to compare overall survival(OS)and cancer-specific survival(CSS).Logistic regression was performed to identify independent risk factors.Cox regression was used to identify independ-ent prognostic factors.Results:Based on the observation of large sample size study cohort data from SEER data-base,the incidence trends for PCa and PCa+1st PM group revealed an increase until 1992 years,then followed by a fluctuating decrease.Multi-Logistic regression illustrated that chemotherapy for PCa was associated with increased risk of developing SPM(OR=1.43,95％CI 1.181-1.730,P＜0.001).The non-SPM group had better OS than PCa+1stPM group(P＜0.001).Cox regression indicated that existed SPM was an independent prognostic factor for poorer OS compared to PCa group.Surgery or radiation for PCa was linked with a better OS and CSS than non-sur-gery or radiation.Conclusion:Chemotherapy for PCa is associated with increased risk of developing SPM and can not improve prognosis.SPM was an independent prognostic factor for poorer OS for PCa patients.Surgical treatment and radiotherapy of PCa are effective in reducing the risk of SPM and benefiting patient survival.The specific nomo-gram model of PCa with SPM constructed in this study can effectively predict the prognosis of this population.
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万方数据
