Kliment Jan, Elias Boris, Baluchova Katarina, Kliment Jan
Department of Urology, Jessenius School of Medicine, Comenius University, Martin, Slovak Republic.
Biomedical Center, Division of Oncology, Jessenius School of Medicine, Comenius University, Martin, Slovak Republic.
Cent European J Urol. 2017;70(1):13-19. doi: 10.5173/ceju.2017.897. Epub 2017 Jan 3.
The study aimed to assess long-term outcomes in patients with very high-risk prostate cancer (PCa) - pT3b-T4 N0-1 using the definitive histopathology following radical retropubic prostatectomy (RRP).
We have analyzed 114 patients with very high-risk PCa who underwent RRP between 1995 and 2012. Biochemical and clinical progression-free survival (BPFS, CPFS), cancer-specific and overall survival (CSS, OS) curves were constructed according to the Kaplan-Meier method. Univariate and multivariate Cox regression analysis was utilized to determine predictability of clinical and pathological parameters.
At the 5 and 10 year mark, the BPFS was 71.3% and 35%, respectively; the CPFS was 86.8% and 69.2%, respectively; the CSS was 98% and 76.3%, respectively and the OS was 90.3% and 62.4%, respectively. Sixteen patients (14%) had lymph-node involvement. Positive surgical margins were present in 64 (56.1%) patients. Neo-adjuvant androgen deprivation therapy (ADT) was received by 22 (19.3%) patients. Adjuvant ADT alone or in combination with external radiotherapy was received by 59 (51.8%) patients. No adjuvant treatment was needed in 29 (25.4%) patients. In univariate and multivariate analysis, neo-adjuvant ADT was associated with an increased risk of BPFS and CPFS.
Therapy applied in patients with very high-risk PCa was multimodal in most cases, with RP usually being the first step. The study confirmed that very high-risk PCa is a heterogeneous disease. A significant subset of patients remain without adjuvant therapy treatment.
本研究旨在通过耻骨后根治性前列腺切除术（RRP）后的最终组织病理学评估极高风险前列腺癌（PCa）-pT3b-T4 N0-1患者的长期预后。
我们分析了1995年至2012年间接受RRP的114例极高风险PCa患者。根据Kaplan-Meier方法构建生化和临床无进展生存期（BPFS、CPFS）、癌症特异性生存期和总生存期（CSS、OS）曲线。采用单因素和多因素Cox回归分析来确定临床和病理参数的预测性。
在5年和10年时，BPFS分别为71.3%和35%；CPFS分别为86.8%和69.2%；CSS分别为98%和76.3%；OS分别为90.3%和62.4%。16例患者（14%）有淋巴结受累。64例（56.1%）患者存在手术切缘阳性。22例（19.3%）患者接受了新辅助雄激素剥夺治疗（ADT）。59例（51.8%）患者接受了单独或联合外照射放疗的辅助ADT。29例（25.4%）患者无需辅助治疗。在单因素和多因素分析中，新辅助ADT与BPFS和CPFS风险增加相关。
大多数极高风险PCa患者接受的治疗是多模式的，通常以RP为第一步。该研究证实极高风险PCa是一种异质性疾病。相当一部分患者无需辅助治疗。
