Hull Gerald W, Rabbani Farhang, Abbas Farhat, Wheeler Thomas M, Kattan Michael W, Scardino Peter T
Department of Urology, Medical University of South Carolina, Charleston, USA.
J Urol. 2002 Feb;167(2 Pt 1):528-34. doi: 10.1016/S0022-5347(01)69079-7.
We analyzed the long-term progression-free probability after radical retropubic prostatectomy in a consecutive series of patients with localized prostate cancer.
From 1983 to 1998, 1,000 patients (median age 62.9 years, range 37.7 to 81.4) with clinical stage T1 to T2 prostate cancer were treated with radical retropubic prostatectomy and pelvic lymphadenectomy, without other cancer related therapy before recurrence. Mean followup was 53.2 months (median 46.9, range 1 to 170).
Ten years after radical retropubic prostatectomy the mean probability +/- 2 standard errors that patients remained free of progression and of any further treatment was 75.0% +/- 3.7% and of metastasis 84.2% +/- 4.4%. Mean actuarial cancer specific survival rate +/- 2 standard error was 97.6% +/- 1.7%. In a multivariate analysis pretreatment prostate specific antigen level (p <0.0001), biopsy Gleason sum (p <0.0001) and clinical stage (p=0.0071) were independent prognostic factors for progression. After prostatectomy independent risk factors were Gleason sum in the prostatectomy specimen (p=0.0008), extracapsular extension (p=0.0019), seminal vesical involvement (p <0.0001), lymph node metastasis (p <0.0001) and surgical margin status (p <0.0001). Margins were positive in 12.8% of cases. At 10 years postoperatively radical retropubic prostatectomy was effective for cancer confined to the prostate (92.2% progression-free probability) and also not confined (52.8%), including 71.4% progression-free probability for patients with only extracapsular extension and 37.4% with seminal vesicle invasion without lymph node metastasis.
Radical retropubic prostatectomy provided long-term cancer control in 75% of patients with clinically localized prostate cancer and was effective in the majority of those with high risk cancer, including T2c or biopsy Gleason sum 8 to 10, or PSA greater than 20 ng./ml. Further research should address identifying patients who can safely avoid aggressive therapy.
我们分析了一系列连续性局限性前列腺癌患者行耻骨后根治性前列腺切除术后的长期无进展概率。
1983年至1998年，1000例临床分期为T1至T2期前列腺癌患者（中位年龄62.9岁，范围37.7至81.4岁）接受了耻骨后根治性前列腺切除术及盆腔淋巴结清扫术，复发前未接受其他癌症相关治疗。平均随访时间为53.2个月（中位时间46.9个月，范围1至170个月）。
耻骨后根治性前列腺切除术后10年，患者无进展且无需进一步治疗的平均概率±2个标准误为75.0%±3.7%，无转移的概率为84.2%±4.4%。平均精算癌症特异性生存率±2个标准误为97.6%±1.7%。多因素分析显示，术前前列腺特异性抗原水平（p<0.0001）、活检Gleason评分总和（p<0.0001）及临床分期（p=0.0071）是进展的独立预后因素。前列腺切除术后的独立危险因素包括前列腺切除标本中的Gleason评分总和（p=0.0008）、包膜外侵犯（p=0.0019）、精囊受累（p<0.0001）、淋巴结转移（p<0.0001）及手术切缘状态（p<0.0001）。12.8%的病例切缘阳性。术后10年，耻骨后根治性前列腺切除术对局限于前列腺的癌症有效（无进展概率为92.2%），对非局限性癌症也有效（无进展概率为52.8%），包括仅包膜外侵犯患者的无进展概率为71.4%，精囊侵犯但无淋巴结转移患者的无进展概率为37.4%。
耻骨后根治性前列腺切除术使75%的临床局限性前列腺癌患者获得了长期癌症控制，对大多数高危癌症患者有效，包括T2c期或活检Gleason评分总和为8至10分或前列腺特异性抗原大于20 ng/ml的患者。进一步的研究应致力于识别能够安全避免积极治疗的患者。
