Rampersaud Edward N, Sun Leon, Moul Judd W, Madden John, Freedland Stephen J
Division of Urologic Surgery, Duke Prostate Center, Durham, North Carolina, USA.
J Urol. 2008 Aug;180(2):571-6; discussion 576. doi: 10.1016/j.juro.2008.04.017. Epub 2008 Jun 12.
Percent tumor involvement has been associated with biochemical progression in organ confined disease, although its role in predicting outcome in men with more advanced disease pathology is unclear. We hypothesized percent tumor involvement may be a good correlate of outcome in all stages of prostate cancer.
We examined the association between percent tumor involvement in the radical prostatectomy specimen and the outcome measures of pathological stage and biochemical progression using multivariate logistic regression and Cox proportional hazards analysis, respectively, in 2,220 patients from the Duke Prostate Center radical prostatectomy database.
On multivariate analysis, percent tumor involvement significantly predicted the risk of positive margins (p <0.001), extracapsular extension (p <0.001), seminal vesicle invasion (p <0.001) and biochemical progression (HR 1.16, 95% CI 1.01-1.33, p = 0.035). The percent tumor involvement cut points of 5% or less, 6% to 20%, 21% to 50% and greater than 50% significantly separated men in groups with differing biochemical progression risk (p <0.001). In addition, these cut points were further able to stratify men among those with organ confined margin negative disease (p <0.001), either positive margins or extracapsular extension (p <0.001), and those with seminal vesicle invasion (p = 0.02).
Percent tumor involvement was a significant predictor of biochemical progression and was able to further stratify men who were already assigned to narrowly defined pathological groups. If confirmed in other studies, percent tumor involvement may enable the clinician to identify the high risk patient who stands to benefit the most from adjuvant therapy.
肿瘤累及百分比与局限于器官的疾病的生化进展相关，尽管其在预测疾病病理更晚期男性患者预后中的作用尚不清楚。我们推测肿瘤累及百分比可能是前列腺癌所有阶段预后的良好相关指标。
我们分别使用多变量逻辑回归和Cox比例风险分析，在来自杜克前列腺中心根治性前列腺切除术数据库的2220例患者中，研究根治性前列腺切除标本中的肿瘤累及百分比与病理分期及生化进展等预后指标之间的关联。
多变量分析显示，肿瘤累及百分比显著预测了切缘阳性风险（p<0.001）、包膜外侵犯风险（p<0.001）、精囊侵犯风险（p<0.001）及生化进展风险（风险比1.16，95%可信区间1.01 - 1.33，p = 0.035）。肿瘤累及百分比切点为5%及以下、6%至20%、21%至50%和大于50%时，可显著区分生化进展风险不同的男性患者组（p<0.001）。此外，这些切点还能够进一步对局限于器官且切缘阴性的患者（p<0.001）、切缘阳性或包膜外侵犯的患者（p<0.001）以及精囊侵犯的患者（p = 0.02）进行分层。
肿瘤累及百分比是生化进展的重要预测指标，并且能够进一步对已被归入狭义病理组的男性患者进行分层。如果在其他研究中得到证实，肿瘤累及百分比可能使临床医生能够识别出最能从辅助治疗中获益的高危患者。
