James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD 21224, USA.
Urology. 2012 Nov;80(5):1075-9. doi: 10.1016/j.urology.2012.07.040. Epub 2012 Sep 18.
To analyze the National Comprehensive Cancer Network prostate cancer guidelines pretreatment risk groups in a contemporary series of patients treated with radical prostatectomy.
We analyzed our institutional radical prostatectomy database, including all patients with clinically localized disease treated from 2000 to 2010. Using the National Comprehensive Cancer Network guidelines, the patients were classified into low-, intermediate-, or high-risk groups. The pathologic outcomes were assessed, and the biochemical recurrence (BCR)-free survival rates were calculated and compared using the log-rank test and Cox proportional hazards analysis.
A total of 12 821 men met the inclusion criteria. The pathologic and 10-year BCR-free survival rates differed significantly by risk group (low risk, 92.1%; intermediate risk, 71.0%; and high risk, 38.8%; P < .01). Among the intermediate-risk men, the 10-year BCR-free survival was significantly greater for men assigned to the intermediate-risk group by clinical stage (88.8%) than for those deemed intermediate risk by the Gleason score (73.6%) or prostate-specific antigen (PSA) level (79.5%; P = .01). Likewise, in the high-risk men, a trend was seen toward improved 5-year BCR-free survival for patients with clinical stage T3a tumors (77.8%) compared with those considered high risk because of the Gleason score (53.7%) or PSA level (41.0%; P = .13). On multivariate analysis, clinical stage, Gleason score, and PSA level were all significantly associated with BCR.
We observed heterogeneous outcomes among patients within the National Comprehensive Cancer Network intermediate- and high-risk groups. The BCR-free survival rates were superior for men with an advanced clinical stage compared with those with an advanced Gleason score or elevated PSA level. This within-group heterogeneity must be considered when choosing the treatment modality and predicting an individual patient's prognosis.
分析美国国家综合癌症网络（National Comprehensive Cancer Network，NCCN）前列腺癌指南在一组接受根治性前列腺切除术治疗的当代患者中的预处理风险组。
我们分析了本机构的根治性前列腺切除术数据库，其中包括 2000 年至 2010 年期间治疗的所有局部疾病患者。根据 NCCN 指南，将患者分为低危、中危或高危组。评估病理结果，并使用对数秩检验和 Cox 比例风险分析计算和比较生化复发（BCR）无复发生存率。
共有 12821 名男性符合纳入标准。风险组之间病理和 10 年 BCR 无复发生存率存在显著差异（低危组为 92.1%，中危组为 71.0%，高危组为 38.8%；P<0.01）。在中危组患者中，按临床分期分配到中危组的患者（88.8%）10 年 BCR 无复发生存率显著大于根据 Gleason 评分（73.6%）或前列腺特异性抗原（PSA）水平（79.5%）定义为中危的患者（P=0.01）。同样，在高危组中，与因 Gleason 评分（53.7%）或 PSA 水平（41.0%）而被认为高危的患者相比，临床分期为 T3a 肿瘤的患者（77.8%）5 年 BCR 无复发生存率有改善趋势（P=0.13）。多变量分析显示，临床分期、Gleason 评分和 PSA 水平均与 BCR 显著相关。
我们观察到 NCCN 中危和高危组患者之间存在异质性结局。与 Gleason 评分较高或 PSA 水平升高的患者相比，临床分期较晚的患者 BCR 无复发生存率更高。在选择治疗方式和预测个体患者预后时，必须考虑这种组内异质性。
