Winkler M H, Khan F A, Hoh I M, Okeke A A, Sugiono M, McInerney P, Boustead G B, Persad R, Kaisary A V, Gillatt D A
Royal Free Hospital, London, UK.
BJU Int. 2004 Apr;93(6):725-9. doi: 10.1111/j.1464-410X.2003.04715.x.
To report an audit of preoperative staging variables, case selection, stage migration and prostate-specific antigen (PSA) recurrence at five large centres in the south of England. To establish PSA outcome values after radical prostatectomy for clinically localized prostate cancer in the UK, and enable appropriate patient counselling.
The notes of 854 patients were audited for preoperative staging variables and follow-up data obtained. Patients with neoadjuvant and adjuvant treatment, and with incomplete data and follow-up, were excluded.
The median follow-up was 52 months for the remaining 663 patients; the median PSA level was 10 ng/mL. There was a large migration towards lower PSA and stage; this translated into improved PSA survival rates. The overall Kaplan-Meier PSA recurrence-free survival probability at 1, 3, 5 and 8 years was 0.83, 0.69, 0.60 and 0.48, respectively. The 5-year PSA recurrence-free survival probabilities for PSA levels of < 4, 4.1-10, 10.1-20 and > 20 ng/mL were 0.82, 0.73, 0.59 and 0.20, respectively (Wilcoxon, P < 0.001). The PSA recurrence-free survival probabilities for biopsy Gleason grade 2-4, 5 and 6, 7 and 8-10 at 5 years were 0.70, 0.61, 0.55 and 0.21, respectively (Wilcoxon, P < 0.001). Similarly, the 5-year PSA recurrence-free survival probabilities for clinical stages T1a and 1b, T1c, T2a and T2b were 0.79, 0.62, 0.57 and 0.44, respectively (Wilcoxon, P = 0.0012).
With better case selection the intermediate oncological outcome has improved over time in the UK. PSA recurrence-free survival estimates are less optimistic than the frequently quoted American values. The present values may be used to help in counselling British patients before radical prostatectomy.
报告对英格兰南部五个大型中心术前分期变量、病例选择、分期迁移和前列腺特异性抗原（PSA）复发情况的审计。确定英国临床局限性前列腺癌根治性前列腺切除术后的PSA结局值，以便为患者提供适当的咨询。
对854例患者的病历进行术前分期变量和随访数据的审计。排除接受新辅助和辅助治疗、数据及随访不完整的患者。
其余663例患者的中位随访时间为52个月；中位PSA水平为10 ng/mL。出现了向较低PSA水平和分期的大幅迁移；这转化为PSA生存率的提高。1、3、5和8年时总的Kaplan-Meier PSA无复发生存概率分别为0.83、0.69、0.60和0.48。PSA水平<4、4.1 - 10、10.1 - 20和>20 ng/mL时，5年PSA无复发生存概率分别为0.82、0.73、0.59和0.20（Wilcoxon检验，P<0.001）。活检Gleason分级2 - 4、5、6、7和8 - 10时，5年PSA无复发生存概率分别为0.70、0.61、0.55和0.21（Wilcoxon检验，P<0.001）。同样，临床分期T1a和1b、T1c、T2a和T2b时，5年PSA无复发生存概率分别为0.79、0.62、0.57和0.44（Wilcoxon检验，P =0.0012）。
随着病例选择的改善，英国的中期肿瘤学结局随时间有所改善。PSA无复发生存估计比经常引用的美国数值更不乐观。目前的数值可用于在根治性前列腺切除术之前帮助为英国患者提供咨询。
