Lavallée Luke T, Breau Rodney H, Preston Mark A, Raju Gayanna, Morash Christopher, Doucette Steve, Gerridzen Ronald G, Eastham James, Cagiannos Ilias
Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON;
Can Urol Assoc J. 2011 Dec;5(6):397-401. doi: 10.5489/cuaj.11061.
Tumour density (TD) may be an independent prognostic factor in men with prostate cancer. The purpose of this study was to evaluate the association between prostate cancer TD and recurrence following radical prostatectomy.
Between 1995 and 2007, 645 patients from The Ottawa Hospital or Memorial Sloan-Kettering Cancer Center who had cancer and prostate volumes measured from radical prostatectomy specimens. Tumour density was defined as the relative tumour to prostate volume (tumour volume/prostate volume) and recurrence was defined as a prostate-specific antigen (PSA) >0.2 ng/mL and rising, or postoperative use of radiation or hormonal therapy. Associations between TD and recurrence are adjusted for preoperative PSA, prostatectomy Gleason sum, tumour stage and margin status.
Median follow-up was 40.8 months. Tumour density was associated with preoperative PSA, Gleason sum, tumour stage and surgical margin status (all p < 0.0001). As a continuous variable, TD predicted recurrence-free survival (adjusted HR 1.34 per 10% increase in TD; p = 0.04). As a categorical variable, the group of patients with a TD of >10% had a 2.7 times greater hazard of recurrence compared to patients with a TD <5% (95%CI 1.41, 5.19; p = 0.003). Despite the independent association between TD and recurrence, the clinical value of TD remains in question as the discriminative performance (area under the curve) of predictive models only improved from 0.865 to 0.876.
Prostate cancer TD is associated with known prognostic factors and is also independently predictive of recurrence following radical prostatectomy.
肿瘤密度（TD）可能是前列腺癌男性患者的一个独立预后因素。本研究的目的是评估前列腺癌TD与根治性前列腺切除术后复发之间的关联。
1995年至2007年间，来自渥太华医院或纪念斯隆凯特琳癌症中心的645例患者，其癌症和前列腺体积通过根治性前列腺切除标本进行测量。肿瘤密度定义为肿瘤与前列腺体积的相对值（肿瘤体积/前列腺体积），复发定义为前列腺特异性抗原（PSA）>0.2 ng/mL且持续升高，或术后使用放疗或激素治疗。TD与复发之间的关联根据术前PSA、前列腺切除Gleason评分、肿瘤分期和切缘状态进行调整。
中位随访时间为40.8个月。肿瘤密度与术前PSA、Gleason评分、肿瘤分期和手术切缘状态相关（所有p<0.0001）。作为连续变量，TD预测无复发生存（TD每增加10%，调整后风险比为1.34；p=0.04）。作为分类变量，TD>10%的患者组复发风险是TD<5%患者组的2.7倍（95%CI 1.41，5.19；p=0.003）。尽管TD与复发之间存在独立关联，但TD的临床价值仍存在疑问，因为预测模型的判别性能（曲线下面积）仅从0.865提高到0.876。
前列腺癌TD与已知的预后因素相关，并且也是根治性前列腺切除术后复发的独立预测因素。
