Bianco Fernando J, Wood David P, Cher Michael L, Powell Isaac J, Souza Julia W, Pontes J Edson
Department of Urology, Wayne State University School of Medicine, The Prostate Program, The Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, USA.
Clin Prostate Cancer. 2003 Mar;1(4):242-7. doi: 10.3816/cgc.2003.n.006.
Pathologic stage is a major prognostic factor in patients with clinically localized prostate cancer. However, disease recurrence occurs even in patients with organ-confined disease. With the advent of prostate-specific antigen (PSA) testing, the percentage of patients with pathologically organ-confined tumors has increased significantly. We studied clinical/pathologic factors that will predict disease recurrence in patients with pathologically organ-confined tumors. Patients with clinically localized newly diagnosed prostate cancer who had not received prior therapeutic intervention but who underwent radical prostatectomy as definitive treatment between 1990 and 1999, were included in this study. Clinical/pathologic parameters including age, race, clinical stage, preoperative PSA, and biopsy and specimen Gleason scores (grouped as 2-6, 7, and 8-10) were correlated with disease-free survival in patients with organ-confined disease. Metastasis-free and cancer-specific survival for the cohort was also assessed. A total of 1045 patients fulfilled our inclusion criteria. Overall, the 10-year estimates of PSA progression-free, metastasis-free, and cancer-specific survival were 75%, 91%, and 92%, respectively. Cancer was confined to the prostate in 532 of 1045 patients (51%), of whom 96% (511 of 532) remain PSA progression-free, compared to 65% (335 of 513) with extraprostatic disease (P = 0.0001). Interestingly, in patients with organ-confined disease, the specimen Gleason score was the only prognostic factor for disease recurrence after multivariable analysis. Radical prostatectomy provided excellent cancer control. For patients with pathologically organ-confined tumors, the specimen Gleason score is the only factor predictive of disease-free survival. Of note, Gleason scores of 8-10 are uncommon in these patients.
病理分期是临床局限性前列腺癌患者的主要预后因素。然而，即使是器官局限性疾病患者也会出现疾病复发。随着前列腺特异性抗原（PSA）检测的出现，病理上器官局限性肿瘤患者的比例显著增加。我们研究了可预测病理上器官局限性肿瘤患者疾病复发的临床/病理因素。本研究纳入了1990年至1999年间临床局限性新诊断前列腺癌患者，这些患者未接受过先前的治疗干预，但接受了根治性前列腺切除术作为确定性治疗。临床/病理参数包括年龄、种族、临床分期、术前PSA以及活检和标本Gleason评分（分为2 - 6、7和8 - 10组）与器官局限性疾病患者的无病生存期相关。还评估了该队列的无转移生存期和癌症特异性生存期。共有1045例患者符合我们的纳入标准。总体而言，PSA无进展、无转移和癌症特异性生存期的10年估计值分别为75%、91%和92%。1045例患者中有532例（51%）癌症局限于前列腺，其中96%（532例中的511例）保持PSA无进展，而前列腺外疾病患者为65%（513例中的335例）（P = 0.0001）。有趣的是，在器官局限性疾病患者中，多变量分析后标本Gleason评分是疾病复发的唯一预后因素。根治性前列腺切除术提供了良好的癌症控制。对于病理上器官局限性肿瘤患者，标本Gleason评分是预测无病生存期的唯一因素。值得注意的是，这些患者中Gleason评分为8 - 10的情况并不常见。
