【摘要】 目的:探讨化疗联合转移灶手术对转移性前列腺癌患者总体生存率(overall survival, OS)和癌症特异性生存率(cancer-specific survival, CSS)的影响。方法:本研究基于美国SEER数据库，筛选1975—2021年确诊的转移性前列腺癌患者，共纳入1 120例接受原发灶手术及化疗的患者。其中，1 077例未接受转移灶手术(化疗组),43例接受了转移灶手术(包括远处淋巴结及其他远处转移部位手术)(化疗联合转移灶手术组)。通过倾向性评分匹配(propensity score matching, PSM)方法，平衡2组患者的基线特征，并分别分析化疗组和化疗联合转移灶手术组的OS和CSS。采用Kaplan-Meier生存曲线和多变量Cox比例风险回归模型，评估不同治疗方法对预后的独立影响。结果:匹配前，化疗组的OS(P=0.045)及CSS(P=0.044)均显著优于化疗联合转移灶手术组。匹配后，2组OS差异无统计学意义，但化疗组的CSS仍表现出优势(P=0.049)。多变量Cox回归分析显示，转移灶手术与OS风险显著增加相关(HR=2.711,P=0.021),且CSS风险显著升高(HR=2.826,P=0.027)。结论:化疗联合转移灶手术对转移性前列腺癌患者的总体生存无显著改善，相反有可能增加癌症特异性死亡率的风险。更多还原

【Abstract】 Objective: To explore the effect of chemotherapy combined with metastatic surgery on overall survival(OS) and cancer-specific survival(CSS) in patients with metastatic prostate cancer. Methods: This study was based on the US SEER database and screened patients with metastatic prostate cancer diagnosed from 1975 to 2021. A total of 1 120 patients who underwent primary surgery and chemotherapy were included. The propensity score matching(PSM) method was used to balance the baseline characteristics of the two groups of patients, and the OS and CSS of the chemotherapy monotherapy group and chemotherapy combined with metastatic surgery group were analyzed separately. Kaplan-Meier survival curves and multivariate Cox proportional hazards regression models were used to evaluate the independent effects of different treatments on prognosis. Results: Before matching, the chemotherapy group had significantly better OS(P=0.045) and CSS(P=0.044) than the chemotherapy combined with metastasectomy group. After matching, there was no statistically significant difference in OS between the two groups, but the chemotherapy group still showed a CSS advantage(P=0.049). Multivariable Cox regression analysis showed that metastasectomy was significantly associated with an increased risk of OS(HR=2.711, P=0.021) and CSS(HR=2.826, P=0.027). Conclusion: Chemotherapy combined with metastasectomy does not significantly improve OS in patients with metastatic prostate cancer; instead, it may increase the risk of cancer-specific mortality.更多还原