Milonas Daimantas, Kinčius Marius, Skulčius Giedrius, Matjošaitis Aivaras Jonas, GudinavičienĖ Inga, Jievaltas Mindaugas
Departments of 1Urology.
Scand J Urol. 2014 Aug;48(4):344-9. doi: 10.3109/21681805.2013.870602. Epub 2014 Feb 12.
The aim of the study was to identify the risk of unfavourable disease (≥ pT3 and/or Gleason score ≥ 7) in radical prostatectomy (RP) specimens and biochemical progression-free survival (BPFS) after RP in patients with low-risk prostate cancer detected by D'Amico criteria before surgery.
Between 2004 and 2007, 690 men underwent prostate biopsy and RP at a single university hospital. Of those, 248 patients (35.9%) had low-risk prostate cancer criteria. The endpoints of the study were detection of low-risk (pT2 and Gleason score ≤ 6) or unfavourable (≥ pT3 and/or Gleason score ≥ 7) prostate cancer, and BPFS. The risk of progression was analysed using multivariate Cox regression model and BPFS was established using Kaplan-Meier analysis.
The median follow-up was 60 months (1-112 months). pT3 was detected in 14.1%, and Gleason score ≥ 7 in 32.7% of patients. Unfavourable prostate cancer was detected in 37.5% of patients. Overall biochemical relapse rate was 13.6%. The estimated probability of 3-, 5- and 8-year BPFS for all study patients was 90.6%, 88.1% and 77.9%, respectively. Eight-year BPFS was 83.3% for low-risk prostate cancer and 68.2% for unfavourable prostate cancer (p = 0.007). Positive surgical margins (p = 0.0001) and postoperative Gleason score (p = 0.023) were the most significant predictors of biochemical relapse in Cox regression analysis.
The D'Amico criteria may underestimate potentially aggressive prostate cancer in up to 37.5% of patients. Consequently, caution is recommended when the decision concerning the treatment modality is based on D'Amico criteria alone.
本研究旨在确定在手术前根据达米科标准检测出的低风险前列腺癌患者中，根治性前列腺切除术（RP）标本中出现不良疾病（≥pT3和/或Gleason评分≥7）的风险以及RP后的无生化进展生存期（BPFS）。
2004年至2007年期间，690名男性在一家大学医院接受了前列腺活检和RP。其中，248例患者（35.9%）符合低风险前列腺癌标准。研究的终点是检测低风险（pT2和Gleason评分≤6）或不良（≥pT3和/或Gleason评分≥7）前列腺癌以及BPFS。使用多变量Cox回归模型分析进展风险，并使用Kaplan-Meier分析确定BPFS。
中位随访时间为60个月（1 - 112个月）。14.1%的患者检测出pT3，32.7%的患者Gleason评分≥7。37.5%的患者检测出不良前列腺癌。总体生化复发率为13.6%。所有研究患者3年、5年和8年BPFS的估计概率分别为90.6%、88.1%和77.9%。低风险前列腺癌的8年BPFS为83.3%，不良前列腺癌为68.2%（p = 0.007）。在Cox回归分析中，手术切缘阳性（p = 0.0001）和术后Gleason评分（p = 0.023）是生化复发的最显著预测因素。
达米科标准可能会低估高达37.5%患者中潜在侵袭性前列腺癌的情况。因此，仅基于达米科标准做出治疗方式决策时建议谨慎。
