Taguchi Satoru, Fukuhara Hiroshi, Kakutani Shigenori, Takeshima Yuta, Miyazaki Hideyo, Suzuki Motofumi, Fujimura Tetsuya, Nakagawa Tohru, Igawa Yasuhiko, Kume Haruki, Homma Yukio
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan E-mail :
Asian Pac J Cancer Prev. 2014;15(24):10729-33. doi: 10.7314/apjcp.2014.15.24.10729.
Adjuvant androgen deprivation therapy (ADT) is a treatment option for prostate cancer (PC) patients after radical prostatectomy (RP). Although it can achieve a good progression-free survival rate, some patients still develop clinical metastasis. We here investigated risk factors of clinical metastasis in post- prostatectomy patients who received immediate adjuvant ADT.
We identified 197 patients with non-metastatic PC who underwent RP at our institution between 2000 and 2012, followed by adjuvant ADT. The associations of various clinicopathologic factors with clinical metastasis (primary endpoint) and cancer-specific survival (secondary endpoint) were assessed. Multivariate analysis was conducted using a Cox proportional hazards model. Median follow-up was 87 months after RP.
Nine (4.6%) patients developed clinical metastasis and six (3.0%) died from PC. Eight of nine metastatic patients had a pathologic Gleason score (GS) 9 and developed bone metastasis, while the remaining one had pathologic GS 7 and developed metastasis only to para-aortic lymph nodes. On multivariate analyses, pathologic GS ≥9 and regional lymph node metastasis (pN1) were independent predictors of clinical metastasis and pathologic GS ≥9 was an independent predictor of cancer-specific death.
Pathologic GS ≥9 and pN1 were independent predictors of clinical metastasis in post-prostatectomy patients who received immediate adjuvant ADT. Furthermore, pathologic GS ≥9 was an indispensable condition for bone metastasis, which may imply that patients with GS ≤8 on adjuvant ADT are unlikely to develop bone metastasis.
辅助性雄激素剥夺治疗（ADT）是根治性前列腺切除术（RP）后前列腺癌（PC）患者的一种治疗选择。尽管它能实现良好的无进展生存率，但仍有一些患者发生临床转移。我们在此研究接受即刻辅助性ADT的前列腺切除术后患者发生临床转移的危险因素。
我们确定了197例2000年至2012年在本机构接受RP并随后接受辅助性ADT的非转移性PC患者。评估了各种临床病理因素与临床转移（主要终点）和癌症特异性生存（次要终点）之间的关联。使用Cox比例风险模型进行多变量分析。RP后的中位随访时间为87个月。
9例（4.6%）患者发生临床转移，6例（3.0%）死于PC。9例转移患者中有8例病理Gleason评分（GS）为9并发生骨转移，而其余1例病理GS为7且仅发生主动脉旁淋巴结转移。在多变量分析中，病理GS≥9和区域淋巴结转移（pN1）是临床转移的独立预测因素，病理GS≥9是癌症特异性死亡的独立预测因素。
病理GS≥9和pN1是接受即刻辅助性ADT的前列腺切除术后患者临床转移的独立预测因素。此外，病理GS≥9是骨转移的必要条件，这可能意味着接受辅助性ADT且GS≤8的患者不太可能发生骨转移。
