Stephenson Andrew J, Kattan Michael W, Eastham James A, Bianco Fernando J, Yossepowitch Ofer, Vickers Andrew J, Klein Eric A, Wood David P, Scardino Peter T
Glickman Urological and Kidney Institute and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
J Clin Oncol. 2009 Sep 10;27(26):4300-5. doi: 10.1200/JCO.2008.18.2501. Epub 2009 Jul 27.
The long-term risk of prostate cancer-specific mortality (PCSM) after radical prostatectomy is poorly defined for patients treated in the era of widespread prostate-specific antigen (PSA) screening. Models that predict the risk of PCSM are needed for patient counseling and clinical trial design.
A multi-institutional cohort of 12,677 patients treated with radical prostatectomy between 1987 and 2005 was analyzed for the risk of PCSM. Patient clinical information and treatment outcome was modeled using Fine and Gray competing risk regression analysis to predict PCSM.
Fifteen-year PCSM and all-cause mortality were 12% and 38%, respectively. The estimated PCSM ranged from 5% to 38% for patients in the lowest and highest quartiles of predicted risk of PSA-defined recurrence, based on a popular nomogram. Biopsy Gleason grade, PSA, and year of surgery were associated with PCSM. A nomogram predicting the 15-year risk of PCSM was developed, and the externally validated concordance index was 0.82. Neither preoperative PSA velocity nor body mass index improved the model's accuracy. Only 4% of contemporary patients had a predicted 15-year PCSM of greater than 5%.
Few patients will die from prostate cancer within 15 years of radical prostatectomy, despite the presence of adverse clinical features. This favorable prognosis may be related to the effectiveness of radical prostatectomy (with or without secondary therapy) or the low lethality of screen-detected cancers. Given the limited ability to identify contemporary patients at substantially elevated risk of PCSM on the basis of clinical features alone, the need for novel markers specifically associated with the biology of lethal prostate cancer is evident.
对于在广泛开展前列腺特异性抗原（PSA）筛查时代接受治疗的患者，根治性前列腺切除术后前列腺癌特异性死亡率（PCSM）的长期风险尚不清楚。需要预测PCSM风险的模型用于患者咨询和临床试验设计。
分析了1987年至2005年间接受根治性前列腺切除术的12677例患者的多机构队列，以评估PCSM风险。使用Fine和Gray竞争风险回归分析对患者临床信息和治疗结果进行建模，以预测PCSM。
15年PCSM和全因死亡率分别为12%和38%。根据一个常用的列线图，PSA定义复发预测风险处于最低和最高四分位数的患者，估计的PCSM范围为5%至38%。活检Gleason分级、PSA和手术年份与PCSM相关。开发了一个预测15年PCSM风险的列线图，外部验证的一致性指数为0.82。术前PSA速度和体重指数均未提高模型的准确性。只有4%的当代患者预测15年PCSM大于5%。
尽管存在不良临床特征，但很少有患者会在根治性前列腺切除术后15年内死于前列腺癌。这种良好的预后可能与根治性前列腺切除术（无论是否进行辅助治疗）的有效性或筛查发现的癌症低致死率有关。鉴于仅根据临床特征识别PCSM风险显著升高的当代患者的能力有限，显然需要与致命性前列腺癌生物学特性特异性相关的新型标志物。
