Xu David D, Sun Sandy D, Wang Flint, Sun Leon, Stackhouse Danielle, Polascik Thomas, Albala David M, Moul Judd W, Caire Arthur, Robertson Cary N
Division of Urologic Surgery, Duke Prostate Center, Duke University Medical Center, Durham, NC 27710, USA.
Urology. 2009 Sep;74(3):654-8. doi: 10.1016/j.urology.2008.12.063. Epub 2009 Jul 22.
To clarify the relationship between age and pathologic Gleason score and their effect on prostate-specific antigen recurrence (PSAR).
The data from a cohort of 2911 men who had undergone radical prostatectomy from 1988 to 2006 were retrieved from the Duke Prostate Center database. Patient age was divided into 3 groups: <60, 60-64, and >or=65 years. The pathologic Gleason score was divided into 5 groups: <or=5, 6, 3 + 4, 4 + 3, and >7. PSAR was defined as the prostate-specific antigen level increasing to >0.2 ng/mL >30 days after radical prostatectomy. The associations between age and pathologic Gleason score on PSAR and the time to PSAR were analyzed using parametric, nonparametric, Kaplan-Meier, and Cox regression techniques.
Patient age and interval to PSAR had no significant association (P > .05). Kaplan-Meier analysis demonstrated a significant difference in PSAR among age groups. The pathologic Gleason scores of 3 + 3, 3 + 4, 4 + 3, and >7 were significant in determining the incidence of PSAR. Age was not significant for PSAR in patients with a pathologic Gleason score of <or=7. In patients with a pathologic Gleason score of >7, a statistically significant difference was observed among the age groups. Men <60 years old with a pathologic Gleason score >7 had a lower incidence of PSAR than did older men with a similar pathologic Gleason score. A pathologic Gleason score of >or=6 was significant in predicting PSAR.
Age alone was an independent factor in predicting PSAR, but not in predicting the interval to PSAR. The pathologic Gleason score remained a predictor of PSAR, and patient age should be considered in patients with a pathologic Gleason score >7.
明确年龄与病理Gleason评分之间的关系及其对前列腺特异性抗原复发（PSAR）的影响。
从杜克前列腺中心数据库中检索1988年至2006年期间2911例行根治性前列腺切除术的男性队列数据。患者年龄分为3组：<60岁、60 - 64岁和≥65岁。病理Gleason评分分为5组：≤5、6、3 + 4、4 + 3和>7。PSAR定义为根治性前列腺切除术后30天以上前列腺特异性抗原水平升高至>0.2 ng/mL。使用参数、非参数、Kaplan-Meier和Cox回归技术分析年龄和病理Gleason评分与PSAR及PSAR发生时间之间的关联。
患者年龄与至PSAR的间隔无显著关联（P > 0.05）。Kaplan-Meier分析显示各年龄组之间PSAR存在显著差异。病理Gleason评分为3 + 3、3 + 4、4 + 3和>7在确定PSAR发生率方面具有显著意义。病理Gleason评分≤7的患者中，年龄对PSAR无显著影响。在病理Gleason评分>7的患者中，各年龄组之间观察到统计学显著差异。病理Gleason评分>7且年龄<60岁的男性PSAR发生率低于具有相似病理Gleason评分的老年男性。病理Gleason评分≥6在预测PSAR方面具有显著意义。
单独年龄是预测PSAR的独立因素，但不是预测至PSAR间隔的独立因素。病理Gleason评分仍然是PSAR的预测指标，对于病理Gleason评分>7的患者应考虑患者年龄。
