预测根治性前列腺切除术后 15 年前列腺癌特异性死亡率。
Predicting 15-year prostate cancer specific mortality after radical prostatectomy.
机构信息
Section of Urology, University of Chicago Medical Center, Chicago, Illinois, USA.
出版信息
J Urol. 2011 Mar;185(3):869-75. doi: 10.1016/j.juro.2010.10.057. Epub 2011 Jan 15.
PURPOSE
Long-term prostate cancer specific mortality after radical prostatectomy is poorly defined in the era of widespread screening. An understanding of the treated natural history of screen detected cancers and the pathological risk factors for prostate cancer specific mortality are needed for treatment decision making.
MATERIALS AND METHODS
Using Fine and Gray competing risk regression analysis we modeled clinical and pathological data, and followup information on 11,521 patients treated with radical prostatectomy at a total of 4 academic centers from 1987 to 2005 to predict prostate cancer specific mortality. The model was validated on 12,389 patients treated at a separate institution during the same period. Median followup in the modeling and validation cohorts was 56 and 96 months, respectively.
RESULTS
The overall 15-year prostate cancer specific mortality rate was 7%. Primary and secondary Gleason grade 4-5 (each p<0.001), seminal vesicle invasion (p<0.001) and surgery year (p=0.002) were significant predictors of prostate cancer specific mortality. A nomogram predicting 15-year prostate cancer specific mortality based on standard pathological parameters was accurate and discriminating with an externally validated concordance index of 0.92. When stratified by patient age at diagnosis, the 15-year prostate cancer specific mortality rate for pathological Gleason score 6 or less, 3+4, 4+3 and 8-10 was 0.2% to 1.2%, 4.2% to 6.5%, 6.6% to 11% and 26% to 37%, respectively. The 15-year prostate cancer specific mortality risk was 0.8% to 1.5%, 2.9% to 10%, 15% to 27% and 22% to 30% for organ confined cancer, extraprostatic extension, seminal vesicle invasion and lymph node metastasis, respectively. Only 3 of 9,557 patients with organ confined, pathological Gleason score 6 or less cancer died of prostate cancer.
CONCLUSIONS
Poorly differentiated cancer and seminal vesicle invasion are the prime determinants of prostate cancer specific mortality after radical prostatectomy. The prostate cancer specific mortality risk can be predicted with remarkable accuracy after the pathological features of prostate cancer are known.
目的
在广泛筛查的时代，根治性前列腺切除术（radical prostatectomy）后的前列腺癌特异性死亡率（prostate cancer specific mortality）定义较差。为了进行治疗决策，需要了解筛查发现的癌症的治疗自然史和病理危险因素。
材料与方法
使用 Fine 和 Gray 竞争风险回归分析，我们对 11521 例于 1987 年至 2005 年期间在 4 家学术中心接受根治性前列腺切除术治疗的患者的临床和病理数据以及随访信息进行建模，以预测前列腺癌特异性死亡率。该模型在同期于另一家机构接受治疗的 12389 例患者中得到验证。模型建立和验证队列的中位随访时间分别为 56 个月和 96 个月。
结果
总的 15 年前列腺癌特异性死亡率为 7%。原发和次要 Gleason 评分 4-5（均<0.001）、精囊侵犯（<0.001）和手术年份（p=0.002）是前列腺癌特异性死亡率的显著预测因素。基于标准病理参数的预测 15 年前列腺癌特异性死亡率的列线图准确且具有鉴别力，外部验证的一致性指数为 0.92。根据患者诊断时的年龄分层，病理 Gleason 评分 6 或更低、3+4、4+3 和 8-10 的 15 年前列腺癌特异性死亡率分别为 0.2%至 1.2%、4.2%至 6.5%、6.6%至 11%和 26%至 37%。局限于器官的癌症、前列腺外延伸、精囊侵犯和淋巴结转移的 15 年前列腺癌特异性死亡率风险分别为 0.8%至 1.5%、2.9%至 10%、15%至 27%和 22%至 30%。在 9557 例局限于器官、病理 Gleason 评分 6 或更低的癌症患者中，仅有 3 例死于前列腺癌。
结论
分化不良的癌症和精囊侵犯是根治性前列腺切除术后前列腺癌特异性死亡率的主要决定因素。在了解前列腺癌的病理特征后，可非常准确地预测前列腺癌特异性死亡率风险。
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