基于生化复发概率对T1C期前列腺癌进行亚分层。

Substratification of stage T1C prostate cancer based on the probability of biochemical recurrence.

作者信息

Gretzer Matthew B, Epstein Jonathan I, Pound Charles R, Walsh Patrick C, Partin Alan W

机构信息

James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

出版信息

Urology. 2002 Dec;60(6):1034-9. doi: 10.1016/s0090-4295(02)01997-0.

DOI:10.1016/s0090-4295(02)01997-0

PMID:12475665

Abstract

OBJECTIVES

To evaluate the influence of preoperative prostate-specific antigen (PSA), biopsy Gleason sum, and prostate biopsy quantitative histologic findings on the probability of biochemical failure in an attempt to identify criteria to substratify Stage T1c prostate cancer more accurately.

METHODS

We reviewed the records of 1149 patients who underwent prostatectomy for T1c disease between 1988 and 2000. Biochemical recurrence (PSA 0.2 ng/mL or greater) defined the endpoint in this study. Recursive partitioning analysis was used to establish cutpoints for preoperative PSA level, biopsy Gleason sum, number of positive biopsy cores, and maximal percentage of any single biopsy core involved with cancer. These cutoff values were then evaluated using Kaplan-Meier estimations to determine the probability of remaining biochemically recurrence free.

RESULTS

Using a PSA cutpoint of 10 ng/mL or a biopsy Gleason sum of 7, two groups of patients were identified (T1cI and T1cII). The rate of freedom from PSA recurrence at 3, 5, and 10 years after surgery for T1cI was 98%, 96%, and 96%, respectively, and for T1cII was 86%, 83%, and 73%, respectively (P <0.001). For T1cII patients, the greatest percentage of cancer in a single biopsy core was found to be a predictor of biochemical failure on multivariate analysis and, using a cutoff value of 50%, further stratified the PSA recurrence-free rates for the men in group T1cII (90% and 85% versus 75% and 56% at 5 and 10 years after surgery, respectively, P = 0.03).

CONCLUSIONS

The results of this study demonstrate that within Stage T1c there are two populations of patients with significantly different recurrence probabilities: T1cI (Gleason sum less than 7 and PSA 10 ng/mL or less) and T1cII (Gleason sum 7 or greater or PSA greater than 10 ng/mL). Furthermore, using a cutpoint of 50% of cancer in a single core of biopsy tissue, additional risk stratification is afforded to men with higher risk "T1cII" cancer.

摘要

目的

评估术前前列腺特异性抗原（PSA）、活检 Gleason 评分以及前列腺活检定量组织学结果对生化失败概率的影响，以试图确定更准确地对 T1c 期前列腺癌进行亚分层的标准。

方法

我们回顾了 1988 年至 2000 年间因 T1c 疾病接受前列腺切除术的 1149 例患者的记录。本研究中生化复发（PSA≥0.2 ng/mL）定义为终点。采用递归划分分析来确定术前 PSA 水平、活检 Gleason 评分、阳性活检核心数量以及任何单个活检核心中癌组织的最大百分比的切点。然后使用 Kaplan-Meier 估计法评估这些临界值，以确定无生化复发的概率。

结果

使用 PSA 切点为 10 ng/mL 或活检 Gleason 评分为 7，确定了两组患者（T1cI 和 T1cII）。T1cI 组患者术后 3 年、5 年和 10 年的 PSA 无复发率分别为 98%、96%和 96%，T1cII 组分别为 86%、83%和 73%（P<0.001）。对于 T1cII 组患者，多因素分析发现单个活检核心中癌组织的最大百分比是生化失败的一个预测因素，使用 50%的临界值进一步对 T1cII 组男性的 PSA 无复发率进行分层（术后 5 年和 10 年分别为 90%和 85%，而不是 75%和 56%，P = 0.03）。

结论

本研究结果表明，在 T1c 期内有两组患者，其复发概率显著不同：T1cI（Gleason 评分小于 7 且 PSA≤10 ng/mL）和 T1cII（Gleason 评分 7 或更高或 PSA > 10 ng/mL）。此外，使用活检组织单个核心中癌组织占比 50%的临界值，可为高风险的“T1cII”期癌症男性提供额外的风险分层。