Fairey Adrian S, Daneshmand Siamak, Skinner Eila C, Schuckman Anne, Cai Jie, Lieskovsky Gary
USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA.
Department of Urology, Stanford University, Stanford, CA.
Urol Oncol. 2014 Feb;32(2):85-91. doi: 10.1016/j.urolonc.2013.03.005. Epub 2013 Oct 30.
We evaluated long-term cancer control outcomes of radical prostatectomy and bilateral pelvic lymph node dissection (RP) for pT3bN0M0 prostate cancer in the era of prostate-specific antigen (PSA) screening.
A retrospective analysis of prospectively collected data from the University of Southern California Prostate Cancer Database was performed. Between 1987 and 2008, 229 men underwent open RP for pT3bN0M0 prostate cancer. The cohort was divided into early (1987-1997) and contemporary (1998-2008) PSA eras. The Kaplan-Meier method and Cox proportional regression models were used to analyze clinical recurrence (CR) and biochemical recurrence (BCR).
The median follow-up duration was 14.5 years (range, 0.2-21.1y). The predicted 10-year freedom from CR and BCR rates for men treated in the early and contemporary PSA eras were 73% and 95% (Log-rank P = 0.001) and 65% and 73% (Log-rank P = 0.055), respectively. Multivariable analysis showed that pathologic Gleason grade 8-10 (CR: hazard ratio [HR] = 5.11; 95% confidence interval [CI] = 1.72-15.20; P = 0.003; BCR: HR = 3.47; 95% CI = 1.60-7.48; P = 0.002) and contemporary PSA era (CR: HR = 0.15; 95% CI = 0.06-0.41; P<0.001; BCR: HR = 0.49; 95% CI = 0.28-0.86; P = 0.013) were independently associated with cancer control. Adjuvant radiation therapy and positive surgical margins were not independently associated with outcomes.
RP conferred long-term cancer control in men with pT3bN0M0 prostate cancer treated in the PSA era. Pathologic Gleason grade 8-10 and treatment in the early PSA era were independently associated with poorer cancer control outcomes.
我们评估了在前列腺特异性抗原（PSA）筛查时代，根治性前列腺切除术和双侧盆腔淋巴结清扫术（RP）对pT3bN0M0前列腺癌的长期癌症控制效果。
对前瞻性收集自南加州大学前列腺癌数据库的数据进行回顾性分析。1987年至2008年间，229例男性因pT3bN0M0前列腺癌接受了开放性RP手术。该队列被分为早期（1987 - 1997年）和当代（1998 - 2008年）PSA时代。采用Kaplan - Meier方法和Cox比例回归模型分析临床复发（CR）和生化复发（BCR）情况。
中位随访时间为14.5年（范围0.2 - 21.1年）。在早期和当代PSA时代接受治疗的男性，预测的10年无CR和无BCR率分别为73%和95%（对数秩检验P = 0.001）以及65%和73%（对数秩检验P = 0.055）。多变量分析显示，病理Gleason分级8 - 10（CR：风险比[HR] = 5.11；95%置信区间[CI] = 1.72 - 15.20；P = 0.003；BCR：HR = 3.47；95% CI = 1.60 - 7.48；P = 0.002）和当代PSA时代（CR：HR = 0.15；95% CI = 0.06 - 0.41；P < 0.001；BCR：HR = 0.49；95% CI = 0.28 - 0.86；P = 0.013）与癌症控制独立相关。辅助放疗和手术切缘阳性与预后无独立相关性。
在PSA时代，RP为接受治疗的pT3bN0M0前列腺癌男性提供了长期癌症控制。病理Gleason分级8 - 10以及在早期PSA时代接受治疗与较差的癌症控制效果独立相关。
