Abstract：
BACKGROUND: Limited data exist on the impact of the site of metastases on survival in patients with stage IV prostate cancer (PCa).
OBJECTIVE: To investigate the role of metastatic phenotype at presentation on mortality in stage IV PCa.
METHODS: Overall, 3857 patients presenting with metastatic PCa between 1991 and 2009, included in the Surveillance Epidemiology and End Results-Medicare database were evaluated.
UNASSIGNED: Overall and cancer-specific survival rates were estimated in the overall population and after stratifying patients according to the metastatic site (lymph node [LN] alone, bone, visceral, or bone plus visceral). Multivariable Cox regression analyses tested the relationship between the site of metastases and survival. All analyses were repeated in a subcohort of patients with a single metastatic site involved.
CONCLUSIONS: Respectively, 2.8%, 80.2%, 6.1%, and 10.9% of patients presented with LN, bone, visceral, and bone plus visceral metastases at diagnosis. Respective median overall survival and cancer-specific survival were 43 mo and 61 mo for LN metastases, 24 mo and 32 mo for bone metastases, 16 mo and 26 mo for visceral metastases, and 14 mo and 19 mo for bone plus visceral metastases (p<0.001). In multivariable analyses, patients with visceral metastases had a significantly higher risk of overall and cancer-specific mortality versus those with exclusively LN metastases (p<0.001). The unfavorable impact of visceral metastases persisted in the oligometastatic subgroup. Our study is limited by its retrospective design.
CONCLUSIONS: Visceral involvement represents a negative prognostic factor and should be considered as a proxy of more aggressive disease in patients presenting with metastatic PCa. This parameter might indicate the need for additional systemic therapies in these individuals.
RESULTS: Patients with visceral metastases should be considered as affected by more aggressive disease and might benefit from the inclusion in clinical trials evaluating novel molecules.
OBJECTIVE: To investigate the role of metastatic phenotype at presentation on mortality in stage IV PCa.
METHODS: Overall, 3857 patients presenting with metastatic PCa between 1991 and 2009, included in the Surveillance Epidemiology and End Results-Medicare database were evaluated.
UNASSIGNED: Overall and cancer-specific survival rates were estimated in the overall population and after stratifying patients according to the metastatic site (lymph node [LN] alone, bone, visceral, or bone plus visceral). Multivariable Cox regression analyses tested the relationship between the site of metastases and survival. All analyses were repeated in a subcohort of patients with a single metastatic site involved.
CONCLUSIONS: Respectively, 2.8%, 80.2%, 6.1%, and 10.9% of patients presented with LN, bone, visceral, and bone plus visceral metastases at diagnosis. Respective median overall survival and cancer-specific survival were 43 mo and 61 mo for LN metastases, 24 mo and 32 mo for bone metastases, 16 mo and 26 mo for visceral metastases, and 14 mo and 19 mo for bone plus visceral metastases (p<0.001). In multivariable analyses, patients with visceral metastases had a significantly higher risk of overall and cancer-specific mortality versus those with exclusively LN metastases (p<0.001). The unfavorable impact of visceral metastases persisted in the oligometastatic subgroup. Our study is limited by its retrospective design.
CONCLUSIONS: Visceral involvement represents a negative prognostic factor and should be considered as a proxy of more aggressive disease in patients presenting with metastatic PCa. This parameter might indicate the need for additional systemic therapies in these individuals.
RESULTS: Patients with visceral metastases should be considered as affected by more aggressive disease and might benefit from the inclusion in clinical trials evaluating novel molecules.
摘要：
背景：关于IV期前列腺癌（PCa）患者转移部位对生存的影响的数据有限。
目的：研究转移表型在IV期PCa患者的死亡率中的作用。
方法：总的来说，对1991年至2009年期间出现转移性PCa的3857例患者进行了评估，这些患者包括在监测流行病学和最终结果-医疗保险数据库中。
■根据转移部位（仅淋巴结[LN]，骨头,内脏，或骨骼加内脏）。多变量Cox回归分析检测了转移部位与生存之间的关系。在涉及单个转移部位的患者亚组中重复所有分析。
结论：分别，2.8%，80.2%,6.1%,10.9%的患者出现LN，骨头,内脏，诊断时骨和内脏转移。LN转移的中位总生存期和癌症特异性生存期分别为43个月和61个月，骨转移24个月和32个月，16个月和26个月用于内脏转移，骨加内脏转移14mo和19mo（p<0.001）。在多变量分析中，与仅有LN转移的患者相比,有内脏转移的患者的总体死亡和癌症特异性死亡风险显著更高(p<0.001).内脏转移的不利影响在寡转移亚组中仍然存在。我们的研究受限于其回顾性设计。
结论：内脏受累是一个负面的预后因素，应被视为转移性PCa患者更具侵袭性疾病的代表。该参数可能表明这些个体需要额外的全身治疗。
结果：内脏转移患者应被认为是更侵袭性疾病的影响，并可能受益于纳入评估新分子的临床试验。
目的：研究转移表型在IV期PCa患者的死亡率中的作用。
方法：总的来说，对1991年至2009年期间出现转移性PCa的3857例患者进行了评估，这些患者包括在监测流行病学和最终结果-医疗保险数据库中。
■根据转移部位（仅淋巴结[LN]，骨头,内脏，或骨骼加内脏）。多变量Cox回归分析检测了转移部位与生存之间的关系。在涉及单个转移部位的患者亚组中重复所有分析。
结论：分别，2.8%，80.2%,6.1%,10.9%的患者出现LN，骨头,内脏，诊断时骨和内脏转移。LN转移的中位总生存期和癌症特异性生存期分别为43个月和61个月，骨转移24个月和32个月，16个月和26个月用于内脏转移，骨加内脏转移14mo和19mo（p<0.001）。在多变量分析中，与仅有LN转移的患者相比,有内脏转移的患者的总体死亡和癌症特异性死亡风险显著更高(p<0.001).内脏转移的不利影响在寡转移亚组中仍然存在。我们的研究受限于其回顾性设计。
结论：内脏受累是一个负面的预后因素，应被视为转移性PCa患者更具侵袭性疾病的代表。该参数可能表明这些个体需要额外的全身治疗。
结果：内脏转移患者应被认为是更侵袭性疾病的影响，并可能受益于纳入评估新分子的临床试验。
