Department of Urology, APHP, CHU Henri Mondor, Institut National de la Sante et de la Recherche Medicale, Université Paris 12, Créteil, France.
Urology. 2011 Sep;78(3):607-13. doi: 10.1016/j.urology.2011.05.021. Epub 2011 Jul 23.
To estimate the effect of predictive factors for oncologic outcomes after radical prostatectomy (RP) for high-risk prostate cancer (PCa).
A total of 813 patients underwent RP for high-risk PCa in a national retrospective multi-institutional study. High-risk PCa was defined as follows: prostate-specific antigen (PSA) level>20 ng/mL, Gleason score 8-10, and/or clinical Stage T2c-T4 disease. The preoperative criteria of high-risk PCa were studied in a logistic regression model to assess the correlations with the pathologic findings in the RP specimens. The predictive factors isolated or combined in scores were assessed by Cox multivariate and Kaplan-Meier analyses in predicting PSA failure (recurrence-free survival [RFS]) and overall survival (OS).
The median follow-up was 64 months. Organ-confined disease was reported in 36.5%. The 5-year RFS, metastasis-free survival, and OS rate was 74.1%, 96.1%, and 98.6%, respectively. Each preoperative criteria of high-risk PCa was an independent predictor of PSA failure. The PSA failure risk was increased by 1.5- and 2.8-fold in men with 2 and 3 criteria, respectively. The RFS, but not the OS, was significantly different according to the preoperative score (P<.001). The postoperative score was significantly predictive for RFS and OS (P<.001 and P<.035, respectively). The risk of PSA failure was significantly increased with an increasing postoperative score (2-4.6-fold).
National data support evidence that RP can result in encouraging midterm oncologic outcomes for the management of high-risk PCa. At 5 years after surgery, 75% of patients remain disease free. Our easy-to-use risk stratification might help clinicians to better predict the clinical and PSA outcomes of high-risk patients after surgery.
评估根治性前列腺切除术（RP）治疗高危前列腺癌（PCa）后肿瘤学结局的预测因素的影响。
一项全国性回顾性多机构研究共纳入 813 例接受 RP 治疗高危 PCa 的患者。高危 PCa 的定义如下：前列腺特异性抗原（PSA）水平>20ng/ml、Gleason 评分 8-10 和/或临床分期 T2c-T4 疾病。在逻辑回归模型中研究高危 PCa 的术前标准，以评估与 RP 标本中的病理发现的相关性。通过 Cox 多变量和 Kaplan-Meier 分析评估单独或联合评分的预测因素，以预测 PSA 失败（无复发生存[RFS]）和总生存（OS）。
中位随访时间为 64 个月。报告器官局限性疾病 36.5%。5 年 RFS、无转移生存和 OS 率分别为 74.1%、96.1%和 98.6%。高危 PCa 的每项术前标准均是 PSA 失败的独立预测因素。患有 2 项和 3 项标准的男性 PSA 失败风险分别增加了 1.5 倍和 2.8 倍。RFS 但不是 OS 根据术前评分有显著差异（P<.001）。术后评分对 RFS 和 OS 有显著预测意义（P<.001 和 P<.035）。PSA 失败的风险随着术后评分的增加而显著增加（2-4.6 倍）。
全国数据支持证据表明，RP 可使高危 PCa 的管理获得令人鼓舞的中期肿瘤学结果。手术后 5 年，75%的患者无疾病。我们易于使用的风险分层可能有助于临床医生更好地预测高危患者手术后的临床和 PSA 结局。
