Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2013 May;189(5):1707-12. doi: 10.1016/j.juro.2012.11.065. Epub 2012 Nov 15.
Clinical stage has been incorporated into multiple risk stratification models for patients with newly diagnosed prostate cancer. However, the independent prognostic value of this variable remains open to debate. In this study we evaluated the association of clinical stage with death from prostate cancer in men who underwent radical prostatectomy and assessed for changes in its prognostic value over time.
We reviewed the records of 14,842 consecutive patients who underwent radical prostatectomy at our institution between 1970 and 2008 without having received preoperative hormone or radiation therapy. Postoperative disease recurrence was estimated using the Kaplan-Meier method and compared using the log rank test. Multivariate Cox proportional hazard regression models were used to analyze the association of clinical stage with outcome.
A total of 5,725 (38.6%) men were classified as having cT1 tumors, 8,160 (55.0%) cT2 tumors and 957 (6.4%) cT3 disease. On univariate analysis clinical stage was significantly associated with postoperative biochemical recurrence, systemic progression and death from prostate cancer (p <0.001 for each). Moreover on multivariate analysis clinical stage was significantly associated with death from cancer for patients treated before (1.45, p = 0.006) and those treated during (1.96, p <0.001) the prostate specific antigen era. Furthermore, the incorporation of clinical stage into contemporary risk stratification improved the prediction of cancer specific survival (c statistic 0.782 without and 0.802 with clinical stage).
Clinical stage is significantly associated with systemic progression and death from prostate cancer. Inclusion of this variable in multivariate prediction models improves the prediction of systemic progression and cancer specific survival.
临床分期已被纳入多种新诊断前列腺癌患者的风险分层模型。然而，该变量的独立预后价值仍存在争议。在本研究中，我们评估了临床分期与接受根治性前列腺切除术的男性前列腺癌死亡之间的关系，并评估了其随时间变化的预后价值。
我们回顾了 1970 年至 2008 年期间在我们机构接受根治性前列腺切除术且未接受术前激素或放射治疗的 14842 例连续患者的记录。使用 Kaplan-Meier 方法估计术后疾病复发，并使用对数秩检验进行比较。使用多变量 Cox 比例风险回归模型分析临床分期与结局的关系。
共有 5725 例（38.6%）患者被分类为 cT1 肿瘤，8160 例（55.0%）cT2 肿瘤和 957 例（6.4%）cT3 疾病。单因素分析显示，临床分期与术后生化复发、全身进展和前列腺癌死亡显著相关（p <0.001）。此外，多因素分析显示，临床分期与治疗前（1.45，p = 0.006）和治疗期间（1.96，p <0.001）患者的癌症死亡显著相关。此外，临床分期纳入当代风险分层可改善癌症特异性生存的预测（c 统计量 0.782 无临床分期和 0.802 有临床分期）。
临床分期与全身进展和前列腺癌死亡显著相关。将该变量纳入多变量预测模型可提高全身进展和癌症特异性生存的预测。
