Zincke H, Blute M L, Fallen M J, Farrow G M
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905.
J Urol. 1991 Oct;146(4):1053-8. doi: 10.1016/s0022-5347(17)37999-5.
Of 148 patients with clinical stage A1 (32) or A2 (116) disease who had radical prostatectomy only 63% and 62%, respectively, had pathological stage A disease. Although 25% of those with clinical stage A1 and 9% of those with clinical stage A2 disease had no cancer at radical prostatectomy, 12% and 29%, respectively, had pathological stage C disease or higher. Clinical Mayo grade 1 was never associated with extracapsular disease but 60% of those with grade 3 or higher tumor did have extracapsular disease. Over-all survival was comparable to the expected survival. Clinical stage A2 cancer was associated with a significantly higher progression rate (when prostate specific antigen values were considered, p = 0.0011) and cancer death rate (p less than 0.045) than stage A1 disease, whereas pathological stage was not significantly related to disease outcome, possibly because of the use of adjuvant treatment (hormonal or radiation) for some patients with pathological stage C or higher disease. The vagaries of clinical staging associated with stage A disease, as well as the previously documented progression on long-term followup (8 to 10 years) in younger (60 years old or less) patients with stage A1 prostate cancer make radical prostatectomy with its limited morbidity an acceptable treatment choice.
在148例仅接受根治性前列腺切除术的临床A1期（32例）或A2期（116例）疾病患者中，分别只有63%和62%的患者术后病理分期为A期。虽然临床A1期患者中有25%以及临床A2期患者中有9%在根治性前列腺切除术中未发现癌症，但分别有12%和29%的患者术后病理分期为C期或更高。临床梅奥分级1级从未与包膜外疾病相关，但肿瘤分级为3级或更高的患者中有60%存在包膜外疾病。总体生存率与预期生存率相当。与A1期疾病相比，临床A2期癌症的进展率（考虑前列腺特异性抗原值时，p = 0.0011）和癌症死亡率（p < 0.045）显著更高，而病理分期与疾病转归无显著相关性，这可能是因为一些病理分期为C期或更高的患者接受了辅助治疗（激素或放疗）。与A期疾病相关的临床分期的不确定性，以及先前记录的60岁及以下A1期前列腺癌年轻患者在长期随访（8至10年）中的病情进展，使得发病率有限的根治性前列腺切除术成为一种可接受的治疗选择。
