Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
BJU Int. 2010 Dec;106(11):1739-45. doi: 10.1111/j.1464-410X.2010.09484.x.
To evaluate the oncological outcomes of patients with specimen Gleason 8 and 9 prostate cancers and to determine factors that predict biochemical recurrence-free survival (BCRFS) after robot-assisted radical prostatectomy (RARP).
Of 4156 patients who underwent RARP from January 2001 to 2009, we identified 368 men with Gleason 8 or 9 tumours who met the inclusion criteria. BCR was defined as a PSA level of ≥0.2 ng/mL with a second rising value. The Kaplan-Meier method and log-rank test were used to compare BCRFS while factors that predict BCRFS were determined by Cox proportional hazards modelling.
The median age and PSA level were 62 years and 6.4 ng/mL for men with Gleason 8, and 63 years and 6.7 ng/mL for Gleason 9 cancers. The median (interquartile range, IQR) overall follow-up was 23 (10-46) months and 19 (7-37) months for Gleason 8 and 9 tumours, respectively. At 60 months the mean (se) overall BCRFS was 36 (5)% and for Gleason 8 it was 47 (6)% and for Gleason 9 it was 21 (7)% (P < 0.001). At 5 years, extraprostatic extension (pT3a) resulted in BCRFS of 52 (9)% for Gleason 8 tumours and 21 (11)% for Gleason 9 (P= 0.012). On multivariable analysis, lymph node invasion, specimen Gleason score, pathological stage and tumour volume predicted BCRFS.
Early results suggest RARP monotherapy performs comparably to RP for BCRFS in men with high-grade prostate cancer. There are significant oncological differences between Gleason 8 and 9 tumours.
评估标本 Gleason 8 和 9 前列腺癌患者的肿瘤学结局，并确定预测机器人辅助根治性前列腺切除术（RARP）后生化无复发生存（BCRFS）的因素。
2001 年 1 月至 2009 年期间，我们从接受 RARP 的 4156 例患者中，确定了符合纳入标准的 368 名 Gleason 8 或 9 肿瘤患者。BCR 定义为 PSA 水平≥0.2ng/mL 且第二次升高。采用 Kaplan-Meier 方法和对数秩检验比较 BCRFS，同时采用 Cox 比例风险模型确定预测 BCRFS 的因素。
Gleason 8 患者的中位年龄和 PSA 水平分别为 62 岁和 6.4ng/mL，Gleason 9 患者分别为 63 岁和 6.7ng/mL。Gleason 8 和 9 肿瘤的中位（四分位距，IQR）总随访时间分别为 23（10-46）个月和 19（7-37）个月。60 个月时，总体 BCRFS 的平均值（se）为 36（5）%，Gleason 8 为 47（6）%，Gleason 9 为 21（7）%（P<0.001）。5 年时，前列腺外扩展（pT3a）导致 Gleason 8 肿瘤的 BCRFS 为 52（9）%，Gleason 9 为 21（11）%（P=0.012）。多变量分析显示，淋巴结侵犯、标本 Gleason 评分、病理分期和肿瘤体积预测 BCRFS。
早期结果表明，对于高级别前列腺癌患者，RARP 单药治疗与 RP 的 BCRFS 相当。Gleason 8 和 9 肿瘤之间存在显著的肿瘤学差异。
