Boorjian Stephen A, Karnes R Jeffrey, Rangel Laureano J, Bergstralh Eric J, Blute Michael L
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 2008 Apr;179(4):1354-60; discussion 1360-1. doi: 10.1016/j.juro.2007.11.061. Epub 2008 Mar 4.
The D'Amico risk group classification was originally developed to estimate the risk of biochemical recurrence following treatment for localized prostate cancer. We externally validated the ability of the risk groups to predict clinical progression, and cancer specific and overall survival following radical prostatectomy, and identify predictors of outcome in patients with high risk disease.
We evaluated the records of 7,591 consecutive patients who underwent radical prostatectomy at our institution between 1987 and 2003. Postoperative survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to analyze the ability of the risk groups to predict survival and to evaluate the impact of clinicopathological factors on outcome in patients at high risk.
Preoperative risk group stratification predicted the patient risk of biochemical and local recurrence, systemic progression, and cancer specific and overall survival (each p <0.001). The HR of death from prostate cancer after surgery in patients with high or intermediate risk disease was 11.5 (95% CI 5.9 to 22.3, p <0.0001) and 6.3 (95% CI 3.3 to 12.3, p <0.0001), respectively, compared to patients at low risk. In patients in the high risk group biopsy Gleason score (p = 0.006), pathological Gleason score (p = 0.006), pathological tumor stage (p = 0.04), positive lymph nodes (p = 0.02) and positive surgical margins (p = 0.008) predicted death from prostate cancer.
We validated the ability of the risk group stratification to predict disease progression and patient survival following radical prostatectomy. Additional prognostic information from surgical staging may assist in individualized postoperative management, particularly for patients at high risk.
达米科风险组分类最初是为了评估局限性前列腺癌治疗后生化复发的风险。我们对外验证了风险组预测根治性前列腺切除术后临床进展、癌症特异性生存率和总生存率的能力，并确定高危疾病患者的预后预测因素。
我们评估了1987年至2003年间在本机构接受根治性前列腺切除术的7591例连续患者的记录。采用Kaplan-Meier法估计术后生存率。使用Cox比例风险回归模型分析风险组预测生存率的能力，并评估临床病理因素对高危患者预后的影响。
术前风险组分层可预测患者生化和局部复发、全身进展以及癌症特异性生存率和总生存率的风险（各p<0.001）。与低风险患者相比，高危或中危疾病患者术后死于前列腺癌的风险比分别为11.5（95%CI 5.9至22.3，p<0.0001）和6.3（95%CI 3.3至12.3，p<0.0001）。在高危组患者中，活检Gleason评分（p=0.006）、病理Gleason评分（p=0.006）、病理肿瘤分期（p=0.04）、阳性淋巴结（p=0.02）和阳性手术切缘（p=0.008）可预测死于前列腺癌。
我们验证了风险组分层预测根治性前列腺切除术后疾病进展和患者生存的能力。手术分期提供的额外预后信息可能有助于个体化的术后管理，特别是对于高危患者。
