Department of Urology, San Raffaele Hospital, University Vita-Salute, Milan, Italy.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Eur Urol. 2014 Mar;65(3):554-62. doi: 10.1016/j.eururo.2013.09.025. Epub 2013 Sep 27.
According to the TNM staging system, patients with prostate cancer (PCa) with lymph node invasion (LNI) are considered a single-risk group. However, not all LNI patients share the same cancer control outcomes.
To develop and internally validate novel nomograms predicting cancer-specific mortality (CSM)-free rate in pN1 patients.
DESIGN, SETTING, AND PARTICIPANTS: We evaluated 1107 patients with pN1 PCa treated with radical prostatectomy, pelvic lymph node dissection, and adjuvant therapy at two tertiary care centers between 1988 and 2010.
Univariable and multivariable Cox regression models tested the relationship between CSM and patient clinical and pathologic characteristics, which consisted of prostate-specific antigen (PSA) value, pathologic Gleason score, pathologic tumor stage, status of surgical margins, number of positive lymph nodes, and status of adjuvant therapy. A Cox regression coefficient-based nomogram was developed and internally validated.
All 1107 patients received adjuvant hormonal therapy (aHT). Additionally, 35% of patients received adjuvant radiotherapy (aRT). The 10-yr CSM-free rate was 84% in the entire cohort and 87% in patients treated with aRT plus aHT versus 82% in patients treated with aHT alone (p=0.08). At multivariable analyses, PSA value, pathologic Gleason score, pathologic tumor stage, surgical margin status, number of positive lymph nodes, and aRT status were statistically significant predictors of CSM (all p ≤ 0.04). Based on these predictors, nomograms were developed to predict the 10-yr CSM-free rate in the overall patient population and in men with biochemical recurrence. These models showed high discrimination accuracy (79.5-83.3%) and favorable calibration characteristics. These results are limited by their retrospective nature.
Some patients with pN1 PCa have favorable CSM-free rates at 10 yr. We developed and internally validated the first nomograms that allow an accurate prediction of the CSM-free rate in these patients at an individual level.
根据 TNM 分期系统，有淋巴结侵犯（LNI）的前列腺癌（PCa）患者被认为是单一风险组。然而，并非所有 LNI 患者的癌症控制结果都相同。
开发并内部验证新的列线图，以预测 pN1 患者的癌症特异性死亡率（CSM）无复发生存率。
设计、地点和参与者：我们评估了 1988 年至 2010 年在两家三级保健中心接受根治性前列腺切除术、盆腔淋巴结清扫术和辅助治疗的 1107 例 pN1 PCa 患者。
单变量和多变量 Cox 回归模型测试了 CSM 与患者临床病理特征之间的关系，这些特征包括前列腺特异性抗原（PSA）值、病理 Gleason 评分、病理肿瘤分期、手术切缘状态、阳性淋巴结数量和辅助治疗状态。基于 Cox 回归系数的列线图被开发并进行了内部验证。
所有 1107 例患者均接受了辅助激素治疗（aHT）。此外，35%的患者接受了辅助放疗（aRT）。整个队列的 10 年 CSM 无复发生存率为 84%，接受 aRT 加 aHT 治疗的患者为 87%，而仅接受 aHT 治疗的患者为 82%（p=0.08）。多变量分析显示，PSA 值、病理 Gleason 评分、病理肿瘤分期、手术切缘状态、阳性淋巴结数量和 aRT 状态是 CSM 的统计学显著预测因子（均 p≤0.04）。基于这些预测因子，我们开发了预测总体患者人群和生化复发患者的 10 年 CSM 无复发生存率的列线图。这些模型显示了较高的区分准确性（79.5-83.3%）和良好的校准特征。这些结果受到其回顾性的限制。
一些 pN1 PCa 患者在 10 年内有较好的 CSM 无复发生存率。我们开发并内部验证了第一个列线图，可在个体水平上准确预测这些患者的 CSM 无复发生存率。
