攝護腺癌第三期存活率—某區域醫院與全國2018至2022年之比較分析

盧致誠^1.2 范文宙¹ 鄭哲舟¹ 林嘉禾¹ 邱毅平¹ 王脩仁¹ 謝育哲¹

¹奇美醫療財團法人柳營奇美醫院 外科部 泌尿外科 ²國立中正大學 資訊管理學系

Analysis and comparison of national data of stage III Survival Rates of prostate cancer in a Regional teaching Hospital between 2018 and 2022

Chih-Cheng Lu^1,2, Wen-Chou Fan¹, Tse-Chou Cheng¹,Chia-Ho Lin¹, Yi-Ping Chiu¹, Hsiu-JenWang¹, Yu-Che Hsieh¹    

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan

²Department of Information Management, National Chung Cheng University, Chiayi

Purpose:

This report aims to conduct a retrospective analysis of the five-year survival rate among patients diagnosed with stage III prostate cancer (PCa) between 2018 and 2022. The objective is to evaluate the effectiveness of current treatment strategies, investigate the primary causes of death, and propose recommendations for improving future clinical care and treatment protocols.

Materials and Methods:

Data retrieved from Cancer Registry Database of Health Promotion Administration, Ministry of Health and Welfare (HPA). Patients diagnosed with stage III PCa from 2018 to 2022. Retrospective review of patient baseline characteristics, Eastern Cooperative Oncology Group (ECOG) performance status, comorbidity profiles, cancer treatment modalities, and causes of death. Descriptive statistics and cause-of-death attribution analysis were performed.

Results:

Analysis of 20 deceased stage III PCa patients (of 74 total) revealed a cohort aged 69-93 years (mean 82), representing elderly to very elderly individuals. Thirty-five percent had an ECOG score ≥2, indicating poor performance status, and 65% presented with at least one comorbidity, most commonly diabetes, hypertension, chronic kidney disease, or chronic obstructive pulmonary disease (COPD). Forty percent had concurrent primary malignancies. Most (85%) received androgen deprivation therapy (ADT) alone, while 15% received ADT with radiotherapy, deviating from guidelines recommending combined treatment. This deceased cohort was characterized by advanced age, poor performance status, high comorbidity burden, and multiple primary cancers, likely contributing to reduced treatment tolerance and increased infection susceptibility. Infection was the predominant immediate cause of death, often secondary to immunosuppression, malnutrition, and treatment-related toxicities. The discrepancy between treatment received (primarily ADT alone) and guideline recommendations for combined therapy may impact treatment efficacy and survival.  

Conclusion:

In this retrospective cohort analysis, we suggest implementing integrated assessments for elderly patients, including comorbidity management, nutritional support, and functional status optimization to strengthen comprehensive geriatric assessment and establishing care coordination mechanisms for patients with multiple malignancies to harmonize treatment plans across different tumors, minimizing conflicting therapies and cumulative side effects. Enhancing processes for determining and documenting causes of death to improve data completeness and quality for future analyses is needed.