Department of Urology, University of California, San Francisco, USA.
BJU Int. 2010 Feb;105(4):472-5. doi: 10.1111/j.1464-410X.2009.08774.x. Epub 2009 Aug 13.
To determine if prostate tumour volume is an independent prognostic factor in a contemporary cohort of men who had a radical prostatectomy (RP) for clinically localized disease, as the effect of tumour volume on prostate cancer outcomes has not been consistently shown in the era of widespread screening with prostate-specific antigen (PSA).
The study included 856 men who had RP from 1998 to 2007 for localized prostate cancer. Tumour volume based on pathology was analysed as a continuous and categorized (<0.26, 0.26-0.50, 0.51-1.00, 1.01-2.00, 2.01-4.00, >4.00 mL) variable using Cox proportional hazards regression and Kaplan-Meier analysis. A multivariable analysis was also conducted controlling for PSA level, Gleason grade, surgical margins, and pathological stage.
Tumour volume had a positive association with grade and stage, but did not correlate with biochemical recurrence-free survival on univariate analysis as a continuous variable (hazard ratio 1.00, P = 0.09), and was only statistically significant for volumes of >4 mL as a categorical variable. No tumour volume was an independent predictor of prostate cancer recurrence on multivariate analysis. There was no difference between tumour volume and time to cancer recurrence for organ-confined tumours using Kaplan-Meier analysis. In low-risk patients (PSA level <10 ng/mL, Gleason score < or = 6, clinical stage T1c/T2a) tumour volume did not correlate with biochemical recurrence-free survival in univariate or multivariable analysis.
There is no evidence that tumour volume is an independent predictor of prostate cancer outcome and it should not be considered as a marker of tumour risk, behaviour or prognosis.
确定前列腺肿瘤体积是否为接受根治性前列腺切除术（RP）治疗局限性前列腺癌的当代患者的独立预后因素。由于在广泛应用前列腺特异性抗原（PSA）筛查的时代，肿瘤体积对前列腺癌结局的影响尚未得到一致证实，因此需要对此进行研究。
本研究纳入了 856 名于 1998 年至 2007 年间因局限性前列腺癌接受 RP 的患者。基于病理学的肿瘤体积分析为连续变量和分类变量（<0.26、0.26-0.50、0.51-1.00、1.01-2.00、2.01-4.00、>4.00 mL），使用 Cox 比例风险回归和 Kaplan-Meier 分析进行分析。多变量分析还控制了 PSA 水平、Gleason 分级、手术切缘和病理分期。
肿瘤体积与分级和分期呈正相关，但作为连续变量进行单变量分析时与生化无复发生存率无相关性（危险比 1.00，P=0.09），仅在肿瘤体积>4 mL 时作为分类变量具有统计学意义。多变量分析显示，肿瘤体积不是前列腺癌复发的独立预测因素。Kaplan-Meier 分析显示，对于局限于器官的肿瘤，肿瘤体积与癌症复发时间之间无差异。在低危患者（PSA 水平<10 ng/mL、Gleason 评分<或=6、临床分期 T1c/T2a）中，肿瘤体积在单变量或多变量分析中与生化无复发生存率均无相关性。
没有证据表明肿瘤体积是前列腺癌结局的独立预测因素，因此不应将其视为肿瘤风险、行为或预后的标志物。
