根治性前列腺切除术后前列腺外延伸程度与生存的关系。
The relationship between the extent of extraprostatic extension and survival following radical prostatectomy.
机构信息
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
出版信息
Eur Urol. 2015 Feb;67(2):342-6. doi: 10.1016/j.eururo.2014.06.015. Epub 2014 Jun 23.
BACKGROUND
Subclassification of the extent of extraprostatic extension (EPE) in radical prostatectomy (RP) specimens may enhance prognostication for prostate cancer (PCa) patients. Yet optimal criteria for staging, validation within a large cohort, and long-term follow-up are lacking.
OBJECTIVE
To compare biochemical recurrence-free survival (BRFS), PCa-specific survival (PCSS), and overall survival (OS) for focal EPE (pT3aF) and nonfocal EPE (pT3aNF) in a large tertiary-referral center with the Epstein criteria for EPE extent.
DESIGN, SETTING, AND PARTICIPANTS: Between 1982 and 2012, 20 434 men underwent RP, and 15 565 men (76.2%) had available pathologic and survival data. A total of 4216 men with isolated EPE were subclassified into pT3aF (1869 men, 44%) and pT3aNF (2347 men, 56%).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Predictors of BRFS, PCSS, and OS were identified with multivariate Cox proportional hazard models. Covariates included age, preoperative prostate-specific antigen, body mass index, surgery year, Gleason score, and surgical margin status.
RESULTS AND LIMITATIONS
With a median follow-up of 9.0 yr (range: 1-27), 314 men died of PCa, with 1300 deaths from any cause. In a multivariate model, pT3aNF compared with pT3aF was an independent predictor of BRFS (hazard ratio [HR]: 1.39; 95% confidence interval [CI], 1.18-1.62; p<0.001), but not of PCSS (HR: 1.38; 95% CI, 0.89-2.11; p=0.146) or OS (HR: 1.13; 95% CI, 0.94-1.36; p=0.197). Ten-year BRFS, PCSS, and OS for pT3aF and pT3aNF were 76% versus 59%, 98% versus 96%, and 95% versus 90%, respectively.
CONCLUSIONS
In a large RP cohort, subclassification of EPE extent with the Epstein criteria improves correlation with BRFS. PCSS and OS in men with isolated EPE (pT3a) are excellent and are not significantly different between pT3aF and pT3aNF. The EPE extent should be subclassified to identify a subgroup of men with a higher risk of recurrence (pT3aNF) and to consider them for additional therapy.
PATIENT SUMMARY
Subclassification of extraprostatic extension (EPE) with the Epstein criteria improves correlation with biochemical recurrence-free survival. Prostate cancer-specific survival and overall survival in men with isolated EPE (pT3a) are excellent and are not significantly different between pT3aF and pT3aNF.
背景
在根治性前列腺切除术（RP）标本中对前列腺外延伸（EPE）程度进行亚分类可能会增强对前列腺癌（PCa）患者的预后判断。然而，缺乏用于分期的最佳标准、在大型队列中的验证以及长期随访。
目的
比较在大型三级转诊中心中，采用 Epstein 标准对 EPE 程度进行亚分类的局限性 EPE（pT3aF）和非局限性 EPE（pT3aNF）的生化无复发生存率（BRFS）、PCa 特异性生存率（PCSS）和总生存率（OS），与 Epstein 标准进行比较。
设计、地点和参与者：1982 年至 2012 年期间，20434 名男性接受了 RP，15565 名男性（76.2%）有可用的病理和生存数据。共有 4216 名孤立性 EPE 患者被分为 pT3aF（1869 名男性，44%）和 pT3aNF（2347 名男性，56%）。
测量和统计分析
使用多变量 Cox 比例风险模型确定 BRFS、PCSS 和 OS 的预测因素。协变量包括年龄、术前前列腺特异性抗原、体重指数、手术年份、Gleason 评分和手术切缘状态。
结果和局限性
中位随访时间为 9.0 年（范围：1-27），314 名男性死于 PCa，1300 名男性死于任何原因。在多变量模型中，与 pT3aF 相比，pT3aNF 是 BRFS 的独立预测因子（风险比[HR]：1.39；95%置信区间[CI]，1.18-1.62；p<0.001），但不是 PCSS（HR：1.38；95% CI，0.89-2.11；p=0.146）或 OS（HR：1.13；95% CI，0.94-1.36；p=0.197）。pT3aF 和 pT3aNF 的 10 年 BRFS、PCSS 和 OS 分别为 76%对 59%、98%对 96%和 95%对 90%。
结论
在大型 RP 队列中，采用 Epstein 标准对 EPE 程度进行亚分类可提高与 BRFS 的相关性。孤立性 EPE（pT3a）患者的 PCSS 和 OS 非常出色，并且在 pT3aF 和 pT3aNF 之间没有显著差异。应对 EPE 程度进行亚分类，以确定具有更高复发风险（pT3aNF）的男性亚组，并考虑对其进行额外治疗。
患者总结
采用 Epstein 标准对前列腺外延伸（EPE）进行亚分类可提高与生化无复发生存率（BRFS）的相关性。孤立性 EPE（pT3a）患者的 PCa 特异性生存率和总生存率非常出色，并且在 pT3aF 和 pT3aNF 之间没有显著差异。
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