Müller Georg, Rieken Malte, Bonkat Gernot, Gsponer Joel Roman, Vlajnic Tatjana, Wetterauer Christian, Gasser Thomas C, Wyler Stephen F, Bachmann Alexander, Bubendorf Lukas
Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland,
Virchows Arch. 2014 Oct;465(4):429-37. doi: 10.1007/s00428-014-1643-1. Epub 2014 Aug 17.
Currently, no consensus exists on the best method for tumor quantification in prostate cancer (PCA), and its prognostic value remains controversial. We evaluated how a newly defined maximum tumor diameter (MTD) might contribute to the prediction of biochemical recurrence (BCR) in a consecutive series of PCA patients treated with radical prostatectomy (RP). Patients with PCA who underwent RP without neoadjuvant therapy at a single center were included for analysis. MTD was defined as the largest diameter of all identified tumors in all three dimensions (i.e., length, width, or depth) of the prostate ("Basel technique"). Cox regression models addressed the association of MTD with BCR in three risk groups (low risk-prostate-specific antigen (PSA) < 10 ng/ml, pT2, and Gleason score (GS) ≤ 6; intermediate risk-PSA ≥ 10 and <20 ng/ml and/or pT2 and GS = 7; high risk-PSA > 20 ng/ml or pT3 or GS ≥ 8) and whole cohort. Within a median follow-up of 44 months (interquartile range (IQR) 23-66), 48 patients (9.4 %) in the intermediate-risk and high-risk groups experienced BCR. In multivariate Cox regression analysis, PSA, pathological stage (pT stage), GS, positive surgical margins (PSMs), and MTD > 19.5 mm were independent predictors for BCR (p < 0.05). In subgroup analysis, MTD as a nominal variable (<24.5 and >24.5 mm) was the only independent predictor of BCR in the intermediate-risk group (hazard ratio (HR) 9.933, 95 % confidence interval (CI) 2.070-47.665; p < 0.05). MTD is an independent risk factor of BCR in PC patients after RP. The combination of the MTD with other well-known prognostic factors after RP may improve decision-making concerning follow-up intensity or adjuvant treatment.
目前，对于前列腺癌（PCA）肿瘤定量的最佳方法尚无共识，其预后价值仍存在争议。我们评估了新定义的最大肿瘤直径（MTD）如何有助于预测接受根治性前列腺切除术（RP）的连续系列PCA患者的生化复发（BCR）。纳入在单一中心接受无新辅助治疗的RP的PCA患者进行分析。MTD定义为前列腺所有三个维度（即长度、宽度或深度）中所有已识别肿瘤的最大直径（“巴塞尔技术”）。Cox回归模型分析了MTD与三个风险组（低风险——前列腺特异性抗原（PSA）<10 ng/ml、pT2且Gleason评分（GS）≤6；中风险——PSA≥10且<20 ng/ml和/或pT2且GS = 7；高风险——PSA>20 ng/ml或pT3或GS≥8）以及整个队列中BCR的关联。在中位随访44个月（四分位间距（IQR）23 - 66）期间，中风险和高风险组中有48例患者（9.4%）发生BCR。在多变量Cox回归分析中，PSA、病理分期（pT分期）、GS、手术切缘阳性（PSM）以及MTD>19.5 mm是BCR的独立预测因素（p<0.05）。在亚组分析中，MTD作为名义变量（<24.5和>24.5 mm）是中风险组中BCR的唯一独立预测因素（风险比（HR）9.933，95%置信区间（CI）2.070 - 47.665；p<0.05）。MTD是RP后PC患者BCR的独立危险因素。RP后将MTD与其他知名预后因素相结合可能会改善关于随访强度或辅助治疗的决策。
