Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Urology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2016 Jun;195(6):1773-8. doi: 10.1016/j.juro.2015.12.074. Epub 2015 Dec 23.
Lymph node positive (pN+) prostate cancer after radical prostatectomy has wide variability in long-term oncologic outcomes. We present a large institutional series with extended followup to create an oncologic risk stratification system that clarifies the prognostic heterogeneity for patients with pN+ disease after radical prostatectomy.
Men with pN+ prostate cancer after radical prostatectomy during 1987 to 2012 were included in the study. Regression models were created to identify significant predictors of biochemical recurrence, metastasis, cancer specific mortality and overall mortality. A cancer specific mortality risk score was then created and internally validated to stratify patients in terms of risk of cancer specific mortality.
For our cohort of 1,011 men with a median followup of 17.6 years the 20-year rate of cancer specific mortality was 31%. On multivariate Cox regression modeling 3 or more positive nodes (HR 1.75, p=0.003), pathological Gleason score 7 vs 6 (HR 1.74, p=0.04) and 8-10 vs 6 (HR 2.63, p=0.001), and positive surgical margins (HR 1.96, p=0.001) were significantly associated with increased cancer specific mortality, while adjuvant radiotherapy (HR 0.40, p=0.008) was associated with decreased cancer specific mortality. A cancer specific mortality risk score was then created using these 4 variables to stratify patients with markedly different prognoses, yielding 20-year cancer specific mortality rates of 19.1% vs 34% vs 46% (p <0.001) for low, intermediate and high risk categories, respectively.
The prognosis of patients with pN+ prostate cancer varied significantly after radical prostatectomy. A risk score created using the number of positive nodes, pathological Gleason score, margin status and adjuvant radiotherapy status successfully separated patients into low, intermediate and high risk groups.
根治性前列腺切除术后淋巴结阳性（pN+）前列腺癌的长期肿瘤学结局存在广泛差异。我们呈现了一个具有扩展随访的大型机构系列，以创建一个肿瘤学风险分层系统，该系统阐明了根治性前列腺切除术后 pN+疾病患者的预后异质性。
纳入了 1987 年至 2012 年期间接受根治性前列腺切除术治疗的 pN+前列腺癌男性患者。建立回归模型以确定生化复发、转移、癌症特异性死亡率和总死亡率的显著预测因素。然后创建了癌症特异性死亡率风险评分，并进行内部验证，以根据癌症特异性死亡率风险对患者进行分层。
在我们的 1011 名男性患者队列中，中位随访时间为 17.6 年，20 年癌症特异性死亡率为 31%。在多变量 Cox 回归模型中，3 个或更多阳性淋巴结（HR 1.75，p=0.003）、病理 Gleason 评分 7 比 6（HR 1.74，p=0.04）和 8-10 比 6（HR 2.63，p=0.001）以及阳性切缘（HR 1.96，p=0.001）与癌症特异性死亡率增加显著相关，而辅助放疗（HR 0.40，p=0.008）与癌症特异性死亡率降低相关。然后使用这 4 个变量创建了癌症特异性死亡率风险评分，以将具有明显不同预后的患者分层，得到低危、中危和高危组的 20 年癌症特异性死亡率分别为 19.1%、34%和 46%（p<0.001）。
根治性前列腺切除术后 pN+前列腺癌患者的预后差异显著。使用阳性淋巴结数量、病理 Gleason 评分、切缘状态和辅助放疗状态创建的风险评分成功地将患者分为低危、中危和高危组。
