Introduction:Survival outcomes for prostate cancer among specific occupational groups prone to regular medical check-ups vis-à-vis the general population have been understudied. For firefighters, a demographic subject to rigorous medical evaluations, possessing above-average medical expertise, and exposed to specific carcinogens of interest, prostate cancer survival in the US has never been studied.Methods:We conducted a retrospective study, utilizing data from the Florida Cancer Data System spanning 2004 to 2014, coupled with firefighter certification records from the Florida State Fire Marshal’s Office. Our study cohort consisted of 1058 prostate cancer cases among firefighters as well as prostate cases for the Florida general population (n= 150,623). We compared cause-specific survival between the two using Cox regression models adjusted for demographics and clinical characteristics, including PSA levels, Gleason scores, and treatment modalities.Results:Firefighters demonstrated a higher five-year cause-specific survival rate (96.1%, 95% CI: 94.7–97.1%) than the general population (94.2%, 95%CI: 94.1–94.3%). Overall, firefighters’ diagnoses were established at younger ages (median age 63 vs. 67 in the general population), exhibited a higher proportion of localized stage cancers (84.7% vs. 81.1%), and had a greater utilization of surgery (46.4% vs. 37.6%), a treatment modality with a high success rate but potential side effects. In multivariable analysis, firefighters displayed a survival advantage for localized stage (adjusted hazard ratio [aHR] = 0.53; 95%CI: 0.34–0.82). However, for regional or distant stages, firefighters aged 65 and above exhibited a higher risk of death (aHR = 1.84; 95% CI: 1.18–2.86) than the general population.Conclusion:Firefighters experience enhanced prostate cancer survival, primarily in cases diagnosed at localized stages, likely due to increased PSA testing. Nonetheless, for regional or distant stage, survival among older firefighters’ lags behind that of the general population. Further investigations are warranted to unravel factors influencing the development of aggressive disease beyond PSA and Gleason scores in this population, as well as to assess the impact of a higher rate of surgical treatment on firefighters’ quality of life.
引言：针对特定职业群体（尤其是那些定期接受体检的群体）与普通人群在前列腺癌生存结局方面的差异研究尚不充分。以消防员为例，这一群体需接受严格的医学评估、具备高于平均水平的医疗知识、且暴露于特定致癌物中，但其在美国的前列腺癌生存状况从未被研究过。 方法：我们开展了一项回顾性研究，利用佛罗里达州癌症数据系统2004年至2014年的数据，并结合佛罗里达州消防局长办公室的消防员认证记录。研究队列包括1058例消防员前列腺癌病例及佛罗里达州普通人群前列腺癌病例（n=150,623）。我们通过调整人口统计学和临床特征（包括PSA水平、格里森评分和治疗方式）的Cox回归模型，比较了两组人群的特异性生存率。 结果：消防员的五年特异性生存率（96.1%，95% CI：94.7–97.1%）高于普通人群（94.2%，95% CI：94.1–94.3%）。总体而言，消防员确诊年龄更轻（中位年龄63岁，普通人群为67岁），局部期癌症比例更高（84.7% vs. 81.1%），且手术使用率更高（46.4% vs. 37.6%），这是一种成功率较高但可能存在副作用的治疗方式。在多变量分析中，消防员在局部期表现出生存优势（调整后风险比[aHR] = 0.53；95% CI：0.34–0.82）。然而，对于区域期或远处转移期，65岁及以上的消防员死亡风险高于普通人群（aHR = 1.84；95% CI：1.18–2.86）。 结论：消防员的前列腺癌生存率较高，主要体现在局部期确诊的病例中，这可能与PSA检测率较高有关。然而，对于区域期或远处转移期，老年消防员的生存率低于普通人群。未来需进一步研究影响该群体侵袭性疾病发展的因素（超越PSA和格里森评分），并评估较高手术率对消防员生活质量的影响。
Distinct Prostate Cancer Survival Outcomes in Firefighters: A Population-Based Study
肿瘤(癌症)患者之家