新千年的前列腺特异性抗原：前列腺癌预后和根治性前列腺切除术结果的有力预测指标——来自SEARCH数据库的结果

PSA in the new millennium: a powerful predictor of prostate cancer prognosis and radical prostatectomy outcomes--results from the SEARCH database.

作者信息

Freedland Stephen J, Hotaling James M, Fitzsimons Nicholas J, Presti Joseph C, Kane Christopher J, Terris Martha K, Aronson William J, Amling Christopher L

机构信息

Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.

出版信息

Eur Urol. 2008 Apr;53(4):758-64; discussion 765-6. doi: 10.1016/j.eururo.2007.08.047. Epub 2007 Aug 31.

DOI:10.1016/j.eururo.2007.08.047

PMID:17868976

Abstract

OBJECTIVES

As a result of prostate-specific antigen (PSA) screening, most men today with prostate cancer present with localized disease and serum PSA values < 10 ng/ml. Within this context, it is debated whether PSA remains an important prognostic variable in more recently treated patients. We examined the prognostic significance of preoperative PSA to predict pathologic stage and biochemical progression among men undergoing radical prostatectomy in the new millennium (2000-2006).

METHODS

We performed a review of 925 men with prostate cancer treated by radical prostatectomy since 2000 within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. We examined the association between preoperative PSA and risk of adverse pathologic features and biochemical progression using logistic regression and Cox proportional hazards analysis.

RESULTS

After adjusting for multiple clinical preoperative characteristics, higher preoperative PSA values were associated with increased odds of extracapsular extension (p<0.001), positive surgical margins (p<0.001), and seminal vesicle invasion (p<0.001) and increased risk of biochemical progression (p=0.009). When the analyses were limited to the 690 men with a preoperative PSA<10 ng/ml and after adjusting for multiple clinical characteristics, higher preoperative PSA values remained associated with increased risk of biochemical progression (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.06-1.28, p=0.002). Even among the 448 men with a PSA<10 ng/ml and clinical stage T1c disease, preoperative PSA was associated with increased risk of biochemical progression (HR 1.14, 95%CI 1.00-1.31, p=0.047).

CONCLUSIONS

PSA remains an important prognostic marker among men diagnosed with prostate cancer in the new millennium treated with radical prostatectomy and remains an important predictor of outcome even among men with preoperative PSA level < 10 ng/ml.

摘要

目的

由于前列腺特异性抗原（PSA）筛查，如今大多数前列腺癌男性患者表现为局限性疾病，血清PSA值<10 ng/ml。在此背景下，对于PSA在近期接受治疗的患者中是否仍然是一个重要的预后变量存在争议。我们研究了术前PSA在预测新千年（2000 - 2006年）接受根治性前列腺切除术男性患者的病理分期和生化进展方面的预后意义。

方法

我们对自2000年以来在共享平等接入区域癌症医院（SEARCH）数据库中接受根治性前列腺切除术治疗的925例前列腺癌男性患者进行了回顾性研究。我们使用逻辑回归和Cox比例风险分析来研究术前PSA与不良病理特征风险和生化进展之间的关联。

结果

在对多个术前临床特征进行调整后，较高的术前PSA值与包膜外侵犯几率增加（p<0.001）、手术切缘阳性（p<0.001）、精囊侵犯（p<0.001）以及生化进展风险增加（p = 0.009）相关。当分析仅限于术前PSA<10 ng/ml的690例男性患者，并对多个临床特征进行调整后，较高的术前PSA值仍然与生化进展风险增加相关（风险比[HR] 1.16，95%置信区间[CI] 1.06 - 1.28，p = 0.002）。即使在448例PSA<10 ng/ml且临床分期为T1c疾病的男性患者中，术前PSA也与生化进展风险增加相关（HR 1.14，95%CI 1.00 - 1.31，p = 0.047）。