Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota.
J Urol. 2013 Nov;190(5):1735-41. doi: 10.1016/j.juro.2013.05.053. Epub 2013 May 29.
Randomized trials demonstrate a benefit to adjuvant radiation therapy after radical prostatectomy in patients with pathologically locally advanced tumors. However, limited data exist on natural history, specifically in men with extraprostatic extension, and wide variability in outcomes has been reported. We evaluated long-term outcomes in patients with pT3aN0 disease and determined predictors of recurrence in these men.
We evaluated 20,744 patients who underwent radical prostatectomy at our clinic between 1987 and 2011. Of these men 1,073 with pT3aN0 disease were identified who did not receive neoadjuvant or adjuvant therapy. Biochemical recurrence-free survival was estimated using the Kaplan-Meier method. Multivariate stepwise selection was used to develop a prognostic model for biochemical recurrence.
Median followup after radical prostatectomy was 10.9 years, during which 449 patients experienced biochemical recurrence. On stepwise selection preoperative prostate specific antigen (HR 1.3, p=0.0003), clinical tumor stage (HR 1.2, p=0.001), pathological Gleason score (HR 1.9, p<0.0001), surgical margin status (HR 1.6, p<0.0001) and detectable first postoperative prostate specific antigen (HR 2.2, p<0.0001) were significantly associated with biochemical recurrence. Cumulative weighted scores of these variables were used to stratify patients into quintiles according to biochemical recurrence risk. The 15-year biochemical recurrence-free survival rate in the lowest to the highest risk group was 70%, 56%, 44%, 34% and 25%, respectively (p<0.0001). The c-index for this model was 0.69.
We present a model to individualize the estimation of biochemical recurrence in men with pT3aN0 disease at radical prostatectomy. These data may be used for patient counseling, specifically in regard to risk stratification when discussing secondary therapy.
随机试验表明，对于病理局部晚期肿瘤的根治性前列腺切除术后的辅助放疗有获益。然而，关于自然病史的数据有限，特别是在外周延伸的男性中，并且报道的结果差异很大。我们评估了 pT3aN0 疾病患者的长期结果，并确定了这些患者复发的预测因素。
我们评估了 1987 年至 2011 年在我们诊所接受根治性前列腺切除术的 20744 名患者。在这些患者中，有 1073 名患有 pT3aN0 疾病，未接受新辅助或辅助治疗。使用 Kaplan-Meier 方法估计生化无复发生存率。采用逐步多元选择法建立生化复发的预后模型。
根治性前列腺切除术后中位随访时间为 10.9 年，在此期间有 449 例患者发生生化复发。逐步选择中，术前前列腺特异性抗原（HR 1.3，p=0.0003）、临床肿瘤分期（HR 1.2，p=0.001）、病理 Gleason 评分（HR 1.9，p<0.0001）、手术切缘状态（HR 1.6，p<0.0001）和可检测的术后首次前列腺特异性抗原（HR 2.2，p<0.0001）与生化复发显著相关。根据生化复发风险，将这些变量的累积加权评分用于将患者分层为五组。在最低到最高风险组中，15 年生化无复发生存率分别为 70%、56%、44%、34%和 25%（p<0.0001）。该模型的 c 指数为 0.69。
我们提出了一种模型，可以对根治性前列腺切除术后 pT3aN0 疾病患者的生化复发进行个体化估计。这些数据可用于患者咨询，特别是在讨论辅助治疗时，可用于风险分层。
