Freedland Stephen J, Partin Alan W, Epstein Jonathan I, Walsh Patrick C
Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Cancer. 2004 Apr 15;100(8):1646-9. doi: 10.1002/cncr.20145.
The 1997 TNM staging system for prostate carcinoma defines a pT2a disease as a tumor histologically involving one lobe of the prostate and pT2b disease as a tumor histologically involving both prostatic lobes. Whether this distinction provides prognostic significance is unclear. The authors evaluated biochemical outcomes between men with pT2aN0 and pT2bN0 disease.
The authors identified 1606 men with organ-confined disease (pT2N0) who were treated with radical prostatectomy between 1982 and 2003 by one surgeon. Clinical characteristics were compared between men with pT2a and pT2b tumors using rank-sum analysis, and prostate-specific antigen (PSA) recurrence data were compared using log-rank analysis. The significant independent predictors of PSA recurrence were determined using a multivariate Cox proportional hazards model.
There were no significant differences between men with pT2a and pT2b tumors at the time of surgery in terms of clinicopathologic characteristics (biopsy and pathologic Gleason score, serum PSA level, clinical stage, and age). Log-rank analysis revealed no significant differences in time to PSA recurrence between men with pT2a and pT2b tumors (P = 0.755). The 10-year PSA progression-free survival rate was 95% (confidence interval [CI], 92-97%) for men with pT2a tumors and 93% (CI, 90-95%) for men with pT2b tumors. Multivariate analysis showed that the significant predictors of PSA recurrence included serum PSA level, biopsy and pathologic Gleason score, and clinical stage. In the current cohort of men with organ-confined disease, pathologic stage (pT2a vs. pT2b) was not a significant predictor of PSA recurrence on multivariate analysis.
There was no difference in PSA recurrence rates between men with pT2aN0 versus pT2bN0 tumors. In men with organ-confined disease, radical prostatectomy provided excellent 10-year PSA progression-free survival regardless of tumor burden (pT2a vs. pT2b). Consideration should be given to modifying the TNM staging system to eliminate substratification of pT2 tumors.
1997年前列腺癌TNM分期系统将pT2a期疾病定义为组织学上累及前列腺一叶的肿瘤，pT2b期疾病定义为组织学上累及前列腺两叶的肿瘤。这种区分是否具有预后意义尚不清楚。作者评估了pT2aN0和pT2bN0期疾病男性患者的生化转归情况。
作者确定了1606例1982年至2003年间由一名外科医生进行根治性前列腺切除术的局限性疾病（pT2N0）男性患者。采用秩和分析比较pT2a和pT2b肿瘤男性患者的临床特征，采用对数秩分析比较前列腺特异性抗原（PSA）复发数据。使用多变量Cox比例风险模型确定PSA复发的显著独立预测因素。
手术时，pT2a和pT2b肿瘤男性患者在临床病理特征（活检和病理Gleason评分、血清PSA水平、临床分期和年龄）方面无显著差异。对数秩分析显示，pT2a和pT2b肿瘤男性患者的PSA复发时间无显著差异（P = 0.755）。pT2a肿瘤男性患者的10年无PSA进展生存率为95%（置信区间[CI]，92 - 97%），pT2b肿瘤男性患者为93%（CI，90 - 95%）。多变量分析显示，PSA复发的显著预测因素包括血清PSA水平、活检和病理Gleason评分以及临床分期。在当前局限性疾病男性患者队列中，多变量分析显示病理分期（pT2a与pT2b）并非PSA复发的显著预测因素。
pT2aN0与pT2bN0肿瘤男性患者的PSA复发率无差异。在局限性疾病男性患者中，无论肿瘤负荷（pT2a与pT2b）如何，根治性前列腺切除术均可提供出色的10年无PSA进展生存率。应考虑修改TNM分期系统以消除pT2肿瘤的亚分期。
