Berg William T, Danzig Matthew R, Pak Jamie S, Korets Ruslan, RoyChoudhury Arindam, Hruby Gregory, Benson Mitchell C, McKiernan James M, Badani Ketan K
Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York.
Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York.
Prostate. 2015 Jul 1;75(10):1085-91. doi: 10.1002/pros.22992. Epub 2015 Mar 21.
We sought to determine maximum wait times between biopsy diagnosis and surgery for localized prostate cancer, beyond which the rate of adverse pathologic outcomes is increased.
We retrospectively reviewed 4,610 patients undergoing radical prostatectomy between 1990 and 2011. Patients were stratified by biopsy Gleason score and PSA value. For each stratification, χ2 analysis was used to determine the smallest 15-day multiple of surgical delay (e.g., 15, 30, 45…180 days) for which adverse pathologic outcomes were significantly more likely after the time interval than before. Adverse outcomes were defined as positive surgical margins, upgrading from biopsy, upstaging, seminal vesicle invasion, or positive lymph nodes.
Two thousand two hundred twelve patients met inclusion criteria. Median delay was 64 days (mean 76, SD 47). One thousand six hundred seventy-five (75.7%), 537 (24.3%), and 60 (2.7%) patients had delays of <=90, >90, and >180 days, respectively. Twenty-six percent were upgraded on final pathology and 23% were upstaged. The positive surgical margin rate was 24.2% and the positive lymph node rate was 1.1%. Significant increases in the proportion of adverse pathological outcomes were found beyond 75 days in the overall cohort (P = 0.03), 150 days for patients with Gleason <=6, and PSA 0-10 (P = 0.038), 60 days for patients with Gleason 7 and PSA >20 (P = 0.032), and 30 days for patients with Gleason 8-10 and PSA 11-20 (0.041).
In low-risk disease, there is a considerable but not unlimited surgical delay which will not adversely impact the rate of adverse pathologic features found. In higher risk disease, this time period is considerably shorter.
我们试图确定局限性前列腺癌活检诊断与手术之间的最长等待时间，超过该时间后不良病理结果的发生率会增加。
我们回顾性分析了1990年至2011年间接受根治性前列腺切除术的4610例患者。患者按活检Gleason评分和PSA值分层。对于每种分层，采用χ2分析来确定手术延迟的最小15天倍数（如15、30、45…180天），在该时间间隔之后不良病理结果比之前显著更可能出现。不良结果定义为手术切缘阳性、活检分级升级、分期升级、精囊侵犯或淋巴结阳性。
2212例患者符合纳入标准。中位延迟时间为64天（平均76天，标准差47天）。分别有1675例（75.7%）、537例（24.3%）和60例（2.7%）患者的延迟时间≤90天、>90天和>180天。最终病理分级升级的患者占26%，分期升级的患者占23%。手术切缘阳性率为24.2%，淋巴结阳性率为1.1%。在总体队列中，超过75天不良病理结果的比例显著增加（P = 0.03）；Gleason评分≤6且PSA为0 - 10的患者，超过150天不良病理结果的比例显著增加（P = 0.038）；Gleason评分为7且PSA>20的患者，超过60天不良病理结果的比例显著增加（P = 0.032）；Gleason评分为8 - 10且PSA为11 - 20的患者，超过30天不良病理结果的比例显著增加（P = 0.041）。
在低风险疾病中，存在相当长但并非无限制的手术延迟时间，这不会对不良病理特征的发生率产生不利影响。在高风险疾病中，这个时间段要短得多。
