Lee J Joy, Thomas I-Chun, Nolley Rosalie, Ferrari Michelle, Brooks James D, Leppert John T
Department of Urology, Stanford University School of Medicine, Stanford, California.
Prostate. 2015 Feb;75(2):183-90. doi: 10.1002/pros.22903. Epub 2014 Oct 18.
Prostate cancer arises in the transition zone (TZ) in approximately 20-25% of cases. Modern biopsy and surveillance protocols, and advances in prostate cancer imaging, have renewed interest in TZ prostate cancers. We compared TZ and PZ prostate cancer to determine if cancer location is independently associated with better outcomes.
We evaluated an expanded cohort of 1354 men who underwent radical prostatectomy between 1983 and 2003 with updated long-term clinical follow-up. Regression models were used to compare the volume of high-grade (Gleason 4 or 5) cancer and total cancer volume by location. Uni- and multi-variable logistic regression models tested the associations between cancer location and adverse pathologic features. Multivariable proportional hazard models were fit to examine cancer recurrence.
Patients with TZ cancer presented with higher pre-operative serum PSA values (11.07 vs. 7.86 ng/ml) and larger total cancer volume (7.1 vs. 3.8 cc). Patients with TZ cancer had decreased odds of seminal vesicle invasion (OR 0.08, 95% CI 0.03, 0.21), extra-capsular extension (OR 0.56, 95% CI 0.35, 0.92), and lymphovascular invasion (OR 0.48, 95% CI 0.27, 0.87) in multivariable models. TZ cancers were independently associated with decreased hazard of tumor recurrence (HR 0.62, 95% CI 0.43, 0.90).
TZ cancer prostate is associated with favorable pathologic features and better recurrence-free survival despite being diagnosed with larger cancers and higher PSA values. Tumor location should be taken into account when stratifying patient risk before and after prostatectomy, particularly with the evolving role of imaging in prostate cancer management.
约20%-25%的前列腺癌起源于移行区（TZ）。现代活检和监测方案以及前列腺癌成像技术的进步，重新引发了对TZ前列腺癌的关注。我们比较了TZ和外周带（PZ）前列腺癌，以确定癌症位置是否与更好的预后独立相关。
我们评估了1983年至2003年间接受根治性前列腺切除术的1354名男性的扩大队列，并进行了更新的长期临床随访。回归模型用于比较不同位置高级别（Gleason 4或5）癌症的体积和总癌体积。单变量和多变量逻辑回归模型检验了癌症位置与不良病理特征之间的关联。多变量比例风险模型用于检查癌症复发情况。
TZ癌患者术前血清PSA值较高（11.07对7.86 ng/ml），总癌体积较大（7.1对3.8 cc）。在多变量模型中，TZ癌患者精囊侵犯（OR 0.08，95%CI 0.03，0.21）、包膜外侵犯（OR 0.56，95%CI 0.35，0.92）和淋巴管侵犯（OR 0.48，95%CI 0.27，0.87）的几率降低。TZ癌与肿瘤复发风险降低独立相关（HR 0.62，95%CI 0.43，0.90）。
尽管TZ前列腺癌被诊断为更大的癌症且PSA值更高，但它与良好的病理特征和更好的无复发生存率相关。在前列腺切除术前和术后对患者风险进行分层时，应考虑肿瘤位置，尤其是随着成像技术在前列腺癌管理中作用的不断演变。
