Algarra R, Barba J, Merino I, Tienza A, Tolosa E, Robles J E, Zudaire J
Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España.
Actas Urol Esp. 2015 Apr;39(3):144-53. doi: 10.1016/j.acuro.2014.05.009. Epub 2014 Jul 2.
To study the influence, in terms of prognosis, of the finding of seminal vesicle involvement in patients with prostate adenocarcinoma treated with radical prostatectomy.
We reviewed a series of patients with seminal vesicle involvement with clinically localized prostate adenocarcinoma who underwent radical prostatectomy between 1989 and 2009, focusing on their clinical-pathological characteristics, biochemical progression-free survival (BPFS) and specific survival (SS). We assessed the variables that influenced BPFS and designed a risk model.
A total of 127 out of 1,132 patients who underwent surgery (11%) presented seminal vesicle invasion (i.e., pT3b). In the multivariate study of the entire series (Cox model), pT3b affects the BPFS (HR: 2; 95% CI: 1.4-3.3; P=.001). Other influential factors were the affected borders, initial prostate-specific antigen levels, pathological Gleason score and the presence of palpated tumor. The pT3b tumors have poorer clinical-pathological variables when compared with pT2 and pT3a tumors. Sixty-five percent of the patients evidenced biochemical progression. The BPFS was significantly poorer for pT3b (40 ± 4% and 28 ± 4% at 5 and 10 years, respectively) than for pT2 and pT3a (P<.0001). The SS was also poorer in patients with pT3b tumors (91 ± 2% and 76 ± 4% at 5 and 10 years, respectively) (P<.0001). The predictors within the pT3b patient group were: PSA levels >10 ng/mL (HR: 1.9; 95% CI: 1.04-3.6; P=.04) and pathological Gleason score 8-10 (HR: 2.1; 95% CI: 1.2-3.5; P=.03). We designed a risk model that accounts for the variables involved, which entails 2 groups with different BPFS (P=.004): Group 1 (0-1 variable), with a BPFS of 46 ± 7% and 27 ± 8% at 5 and 10 years, respectively; and Group 2 (2 variables), with a BPFS of 14 ± 7% and 5 ± 5% at 5 and 10 years, respectively.
Seminal vesicle involvement severely and negatively affects the BPFS and SS. We designed a risk model with the independent influential variables in BPFS (pathological Gleason score 8-10 and PSA levels >10 ng/mL). This model confirms that pT3b tumors are a heterogeneous group, which includes an important group with better prognosis when surgical treatment is performed.
研究根治性前列腺切除术后精囊受累情况对前列腺腺癌患者预后的影响。
我们回顾了1989年至2009年间接受根治性前列腺切除术的一系列临床局限性前列腺腺癌伴精囊受累的患者，重点关注其临床病理特征、生化无进展生存期（BPFS）和特异性生存期（SS）。我们评估了影响BPFS的变量并设计了一个风险模型。
1132例接受手术的患者中有127例（11%）出现精囊侵犯（即pT3b）。在整个系列的多变量研究（Cox模型）中，pT3b影响BPFS（风险比：2；95%可信区间：1.4 - 3.3；P = 0.001）。其他影响因素包括受影响边界、初始前列腺特异性抗原水平、病理Gleason评分以及可触及肿瘤的存在。与pT2和pT3a肿瘤相比，pT3b肿瘤具有更差的临床病理变量。65%的患者出现生化进展。pT3b的BPFS在5年和10年时显著低于pT2和pT3a（分别为40±4%和28±4%）（P<0.0001）。pT3b肿瘤患者的SS也较差（5年和10年时分别为91±2%和76±4%）（P<0.0001）。pT3b患者组内的预测因素为：前列腺特异性抗原水平>10 ng/mL（风险比：1.9；95%可信区间：1.04 - 3.6；P = 0.04）和病理Gleason评分为8 - 10（风险比：2.1；95%可信区间：1.2 - 3.5；P = 0.03）。我们设计了一个考虑相关变量的风险模型，该模型包含两组具有不同BPFS的患者（P = 0.004）：第1组（0 - 1个变量），5年和10年时的BPFS分别为46±7%和27±8%；第2组（2个变量），5年和10年时的BPFS分别为14±7%和5±5%。
精囊受累严重且负面地影响BPFS和SS。我们设计了一个包含BPFS独立影响变量（病理Gleason评分为8 - 10和前列腺特异性抗原水平>10 ng/mL）的风险模型。该模型证实pT3b肿瘤是一个异质性群体，其中包括一组在进行手术治疗时预后较好的重要患者。
