前列腺穿刺活检术前Gleason评分≥8分的前列腺癌患者根治性前列腺切除术后的结局

Outcome after radical prostatectomy with a pretreatment prostate biopsy Gleason score of >/=8.

作者信息

Manoharan M, Bird V G, Kim S S, Civantos F, Soloway M S

机构信息

Department of Urology, University of Miami School of Medicine, Miami, Florida, USA.

出版信息

BJU Int. 2003 Oct;92(6):539-44. doi: 10.1046/j.1464-410x.2003.04419.x.

DOI:10.1046/j.1464-410x.2003.04419.x

PMID:14511029

Abstract

OBJECTIVE

To determine the outcome and predictors of recurrence in patients with a pretreatment prostate biopsy Gleason score (GS) of >/= 8 and treated with radical prostatectomy (RP).

PATIENTS AND METHODS

We retrospectively reviewed 1048 consecutive patients who underwent RP by one surgeon (M.S.S.); patients who had a pretreatment biopsy GS of >/= 8 were identified. Information was recorded on patient age, initial prostate specific antigen (PSA) level, clinical stage, biopsy GS, pathology GS, extraprostatic extension (EPE), tumour volume, surgical margin status, seminal vesicle invasion (SVI), and lymph node involvement. The results were assessed statistically using the Kaplan-Meier method, univariate log-rank tests and multivariate analysis using Cox's proportional hazards regression.

RESULTS

In all, 123 patients met the initial selection criteria; 44 were excluded from further analyses (five salvage RP, 23 < 1 year follow-up and 16 adjuvant treatment). Thus 79 patients were included in the uni- and multivariate analyses; 25 (31%) patients had a GS of </= 7 in the RP specimen and 54 (69%) remained at GS >/= 8. The mean follow-up was 55 months, the age of the patients 63 years and the mean (sd) initial PSA level 13 (12) ng/mL. The overall biochemical failure rate was 38% (41% if the final GS was >/= 8 and 32% if it was </= 7). For those with a GS of >/= 8 in the RP specimen, 20% (11/54) were organ-confined; two patients (2.5%) in this group developed local recurrence. If the final GS was </= 7, 52% (13/25) were organ-confined. In the univariate analysis, significant risk factors for recurrence were PSA >/= 20 ng/mL, EPE, SVI, a positive surgical margin and tumour volume. Cox's proportional regression indicated that a PSA of >/= 20 ng/mL (hazard ratio 7.9, 95% confidence interval 2.6-24.2, P < 0.001), the presence of EPE (4.2, 1.6-10.9, P = 0.004) and a positive surgical margin (3.8, 1.5-9.7, P = 0.005) were significant independent predictors in a multivariate analysis.

CONCLUSION

RP is a reasonable treatment option for patients with a prostate biopsy GS of >/=8 and clinical stage T1-2. These patients have a high chance of remaining disease-free if their PSA level is </= 20 ng/mL. Patients with a pretreatment biopsy GS of >/= 8 should be counselled about the potential differences between the biopsy and the RP specimen GS.

摘要

目的

确定前列腺穿刺活检 Gleason 评分（GS）≥8 且接受根治性前列腺切除术（RP）治疗的患者的复发结局及预测因素。

患者与方法

我们回顾性分析了由同一位外科医生（M.S.S.）实施 RP 的 1048 例连续患者；确定那些前列腺穿刺活检 GS≥8 的患者。记录患者年龄、初始前列腺特异性抗原（PSA）水平、临床分期、穿刺活检 GS、病理 GS、前列腺外侵犯（EPE）、肿瘤体积、手术切缘状态、精囊侵犯（SVI）及淋巴结受累情况。采用 Kaplan-Meier 法、单因素对数秩检验及使用 Cox 比例风险回归的多因素分析对结果进行统计学评估。

结果

总计 123 例患者符合初始入选标准；44 例被排除在进一步分析之外（5 例挽救性 RP、23 例随访时间<1 年及 16 例辅助治疗）。因此 79 例患者纳入单因素和多因素分析；25 例（31%）患者 RP 标本 GS≤7，54 例（69%）仍为 GS≥8。平均随访时间为 55 个月，患者年龄 63 岁，平均（标准差）初始 PSA 水平为 13（12）ng/mL。总体生化失败率为 38%（如果最终 GS≥8 则为 41%，如果≤7 则为 32%）。对于 RP 标本 GS≥8 的患者，20%（11/54）为器官局限性病变；该组中有 2 例患者（2.5%）发生局部复发。如果最终 GS≤7，52%（13/25）为器官局限性病变。在单因素分析中，复发的显著危险因素为 PSA≥20 ng/mL、EPE、SVI、手术切缘阳性及肿瘤体积。Cox 比例回归表明，PSA≥20 ng/mL（风险比 7.9，95%置信区间 2.6 - 24.2，P<0.001）、存在 EPE（4.2，1.6 - 10.9，P = 0.004）及手术切缘阳性（3.8，1.5 - 9.7，P = 0.