Hashimoto Takeshi, Yoshioka Kunihiko, Nagao Go, Nakagami Yoshihiro, Ohno Yoshio, Horiguchi Yutaka, Namiki Kazunori, Nakashima Jun, Tachibana Masaaki
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Int J Urol. 2015 Feb;22(2):188-93. doi: 10.1111/iju.12624. Epub 2014 Oct 22.
To examine biochemical recurrence after robot-assisted radical prostatectomy in Japanese patients, and to develop a risk stratification model for biochemical recurrence.
The study cohort consisted of 784 patients with localized prostate cancer who underwent robot-assisted radical prostatectomy without neoadjuvant or adjuvant endocrine therapy. The relationships of biochemical recurrence with perioperative findings were evaluated. The prognostic factors for biochemical recurrence-free survival were evaluated using Cox proportional hazard model analyses.
During the follow-up period, 80 patients showed biochemical recurrence. The biochemical recurrence-free survival rates at 1, 3, and 5 years were 92.2%, 85.2% and 80.1%, respectively. In univariate analysis, the prostate-specific antigen level, prostate-specific antigen density, biopsy Gleason score, percent positive core, pathological T stage, pathological Gleason score, lymphovascular invasion, perineural invasion and positive surgical margin were significantly associated with biochemical recurrence. In multivariate analysis, prostate-specific antigen density ≥0.4 (P = 0.0011), pathological T stage ≥3a (P = 0.002), pathological Gleason score ≥8 (P = 0.007) and positive surgical margin (P < 0.0001) were independent predictors of biochemical recurrence. The patients were stratified into three risk groups according to these factors. The 5-year biochemical recurrence-free survival rate was 89.4% in the low-risk group, 65.6% in the intermediate-risk group and 30.3% in the high-risk group.
The prostate-specific antigen density, pathological T stage, pathological Gleason score and positive surgical margin were independent prognostic factors for biochemical recurrence. The risk stratification model developed using these four factors could help clinicians identify patients with a poor prognosis who might be good candidates for clinical trials of alternative management strategies.
研究日本患者机器人辅助根治性前列腺切除术后的生化复发情况，并建立生化复发风险分层模型。
研究队列包括784例局限性前列腺癌患者，这些患者接受了机器人辅助根治性前列腺切除术，未接受新辅助或辅助内分泌治疗。评估生化复发与围手术期结果之间的关系。使用Cox比例风险模型分析评估无生化复发生存的预后因素。
在随访期间，80例患者出现生化复发。1年、3年和5年的无生化复发生存率分别为92.2%、85.2%和80.1%。单因素分析中，前列腺特异性抗原水平、前列腺特异性抗原密度、活检Gleason评分、阳性核心百分比、病理T分期、病理Gleason评分、淋巴管侵犯、神经周围侵犯和手术切缘阳性与生化复发显著相关。多因素分析中，前列腺特异性抗原密度≥0.4（P = 0.0011）、病理T分期≥3a（P = 0.002）、病理Gleason评分≥8（P = 0.007）和手术切缘阳性（P < 0.0001）是生化复发的独立预测因素。根据这些因素将患者分为三个风险组。低风险组5年无生化复发生存率为89.4%，中风险组为65.6%，高风险组为30.3%。
前列腺特异性抗原密度、病理T分期、病理Gleason评分和手术切缘阳性是生化复发的独立预后因素。使用这四个因素建立的风险分层模型可帮助临床医生识别预后不良的患者，这些患者可能是替代管理策略临床试验的合适人选。
