Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2013 Sep;20(9):3133-9. doi: 10.1245/s10434-013-3016-4. Epub 2013 May 30.
This study was designed to assess the independent prognostic value of tumor volume (TV) and whether adding TV provides additional prognostic information for predicting biochemical recurrence (BCR) after radical prostatectomy.
We reviewed the medical records of 1,129 patients who underwent radical prostatectomy between July 2005 and July 2011. TV was categorized as minimal (≤1.0 ml), moderate (1.1-5.0 ml), or extensive (>5.0 ml). Cox regression analysis was performed to identify independent predictors of BCR. The predictive accuracies of Cox's proportional hazard regression models with and without TV were quantified and compared using time-dependent receiver operating characteristic curve analysis.
Increasing TV was associated with higher prostate specific antigen, pathological Gleason score, and pathologic tumor stage. TV was an independent predictor of BCR in multivariate analysis (p<0.001). When patients were stratified by organ-confined and nonorgan-confined tumor groups, TV remained an independent predictor of BCR in organ-confined tumors (p<0.001). In the nonorgan-confined tumor group, a significant difference was found only between extensive versus minimal TV (p=0.023). The predictive accuracy of the Cox regression model increased significantly by adding TV in organ-confined tumor group (0.748 vs. 0.704, p<0.05) but not in nonorgan-confined group (0.742 vs. 0.734, p>0.05).
TV was an independent prognostic predictor of BCR in organ-confined prostate cancers and provided additional prognostic information with increased predictive accuracy. In contrast, TV did not increase the predictive accuracy in nonorgan-confined tumor. TV should be considered as a prognosticator in organ-confined tumors.
本研究旨在评估肿瘤体积（TV）的独立预后价值，以及增加 TV 是否为预测根治性前列腺切除术后生化复发（BCR）提供额外的预后信息。
我们回顾了 2005 年 7 月至 2011 年 7 月期间接受根治性前列腺切除术的 1129 例患者的病历。将 TV 分为最小（≤1.0ml）、中等（1.1-5.0ml）或广泛（>5.0ml）。采用 Cox 回归分析识别 BCR 的独立预测因素。使用时间依赖性接受者操作特征曲线分析比较有无 TV 的 Cox 比例风险回归模型的预测准确性。
TV 增加与前列腺特异性抗原、病理 Gleason 评分和病理肿瘤分期较高相关。TV 是多变量分析中 BCR 的独立预测因素（p<0.001）。当患者按局限性和非局限性肿瘤组分层时，TV 仍然是局限性肿瘤 BCR 的独立预测因素（p<0.001）。在非局限性肿瘤组中，仅在广泛与最小 TV 之间存在显著差异（p=0.023）。在局限性肿瘤组中，添加 TV 显著提高了 Cox 回归模型的预测准确性（0.748 对 0.704，p<0.05），但在非局限性肿瘤组中没有（0.742 对 0.734，p>0.05）。
TV 是局限性前列腺癌 BCR 的独立预后预测因素，并提供了增加预测准确性的额外预后信息。相比之下，TV 并未增加非局限性肿瘤的预测准确性。TV 应被视为局限性肿瘤的预后因素。
