Sengupta Shomik, Blute Michael L, Bagniewski Stephanie M, Inman Brant, Leibovich Bradley C, Slezak Jeffrey M, Myers Robert P, Zincke Horst
Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
BJU Int. 2008 Jan;101(2):170-4. doi: 10.1111/j.1464-410X.2007.07270.x.
To assess progression and survival among patients with small-volume, well-differentiated, organ-confined prostate cancer found at radical retropubic prostatectomy (RRP), often defined as being 'insignificant', thus testing whether they are indeed 'insignificant'.
We identified 6496 men treated for prostate cancer by RRP between 1990 and 1999, and defined 'insignificant' tumours as those in men having a prostate-specific antigen (PSA) level of < 10 ng/mL before RRP, a cancer volume of < or = 0.5 mL, a specimen Gleason of score < or = 6 and stage < or = pT2. Survival was assessed using the Kaplan-Meier method and compared using the two-sided log-rank test.
'Insignificant' tumours were found in 354 (5.5%) men, of whom only one had metastatic progression and none died from prostate cancer, with a median (range) follow-up of 9.2 (0.8-15.6) years. Biochemical progression-free survival (87% vs 85%, respectively, at 10 years, P = 0.5), systemic progression-free survival (100% vs 99%, P = 0.3), overall survival (91% vs 88%, P = 0.16) and cancer-specific survival (100% in each group, P = 0.32) were each similar among men with 'insignificant' prostate cancer and men with low-risk (defined by Gleason score, preoperative PSA level, seminal vesicle and surgical margin status) 'significant' cancer. Clinical stage, biopsy Gleason score and preoperative PSA doubling time were multivariably predictive of 'insignificant' tumours at RRP.
'Insignificant' prostate cancer at RRP is associated with a comparable risk of biochemical progression as low-risk 'significant' cancer. Although clinical predictors for 'insignificant' pathology can be identified, it remains to be established whether such patients can be safely managed conservatively.
评估在根治性耻骨后前列腺切除术（RRP）中发现的小体积、高分化、器官局限性前列腺癌患者的疾病进展和生存率，这类癌症通常被定义为“不显著”，以此检验它们是否真的“不显著”。
我们确定了1990年至1999年间接受RRP治疗前列腺癌的6496名男性，并将“不显著”肿瘤定义为RRP术前前列腺特异性抗原（PSA）水平<10 ng/mL、癌体积<或=0.5 mL、标本Gleason评分<或=6且分期<或=pT2的男性患者的肿瘤。采用Kaplan-Meier方法评估生存率，并使用双侧对数秩检验进行比较。
354名（5.5%）男性发现有“不显著”肿瘤，其中只有1例发生转移进展，无1例死于前列腺癌，中位（范围）随访时间为9.2（0.8 - 15.6）年。“不显著”前列腺癌患者与低风险（由Gleason评分、术前PSA水平、精囊和手术切缘状态定义）“显著”癌症患者的生化无进展生存率（10年时分别为87%对85%，P = 0.5）、全身无进展生存率（100%对99%，P = 0.3）、总生存率（91%对88%，P = 0.16）和癌症特异性生存率（每组均为100%，P = 0.32）均相似。临床分期、活检Gleason评分和术前PSA倍增时间在多变量分析中可预测RRP时的“不显著”肿瘤。
RRP时的“不显著”前列腺癌与低风险“显著”癌症的生化进展风险相当。虽然可以确定“不显著”病理的临床预测因素，但这类患者是否可以安全地进行保守治疗仍有待确定。
