Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Biostatistics, Mayo Clinic, Rochester, Minnesota.
J Urol. 2017 Dec;198(6):1286-1294. doi: 10.1016/j.juro.2017.06.085. Epub 2017 Jun 29.
We sought to independently validate the AJCC (American Joint Committee on Cancer) 8th edition prostate cancer staging classification, which includes the elimination of pT2 subcategories and the reclassification of patients with prostate specific antigen 20 ng/ml or greater and Gleason Grade Group 5 as stage groups III-A and III-C, respectively.
We identified 13,839 men who underwent radical prostatectomy at Mayo Clinic between 1987 and 2011 from our institutional registry. Outcomes included biochemical recurrence-free, metastasis-free and cancer specific survival. Kaplan-Meier analyses and Cox regression models with the c-index were used.
Median followup was 10.5 years (IQR 7.1-15.3). Among patients with pT2 prostate cancer the subclassification demonstrated limited discrimination for biochemical recurrence-free, metastasis-free and cancer specific survival (c-index 0.531, 0.545 and 0.525, respectively). At the same time patients with 7th edition stage group II prostate cancer and prostate specific antigen 20 ng/ml or greater had significantly worse 15-year biochemical recurrence-free survival (42.2% vs 58.8%), metastasis-free survival (78.2% vs 88.8%) and cancer specific survival (88.0% vs 94.4%, all p <0.001) than patients with 7th edition stage group II prostate cancer and prostate specific antigen less than 20 ng/ml. However, patients with 7th edition stage group II prostate cancer and prostate specific antigen 20 ng/ml or greater had significantly better 15-year biochemical recurrence-free survival (42.2% vs 31.3%, p = 0.007), metastasis-free survival (78.2% vs 68.0%, p <0.001) and cancer specific survival (88.0% vs 83.4%, p = 0.01) than patients with 7th edition stage group III. Also, patients with 7th edition stage group II prostate cancer and Gleason Grade Group 5 had significantly worse 15-year biochemical recurrence-free survival (37.1% vs 57.9%, p <0.001), metastasis-free survival (63.8% vs 88.5%, p <0.001) and cancer specific survival (73.0% vs 94.3%, p <0.001) than patients with 7th edition stage group II prostate cancer and Gleason Grade Group 1-4 as well as worse 15-year cancer specific survival (73.0% vs 83.4%, p = 0.005) than patients with 7th edition stage group III prostate cancer.
Our data support the changes in the new AJCC classification.
我们旨在独立验证 AJCC（美国癌症联合委员会）第 8 版前列腺癌分期分类，其中包括消除 pT2 亚分类，并将前列腺特异性抗原（PSA）水平为 20ng/ml 或以上且 Gleason 分级组为 5 的患者重新分类为 III-A 和 III-C 期。
我们从机构登记处确定了 1987 年至 2011 年间在梅奥诊所接受根治性前列腺切除术的 13839 名男性。研究结果包括生化无复发生存、无转移生存和癌症特异性生存。采用 Kaplan-Meier 分析和 Cox 回归模型与 c 指数进行分析。
中位随访时间为 10.5 年（IQR 7.1-15.3）。在 pT2 前列腺癌患者中，亚分类对生化无复发生存、无转移生存和癌症特异性生存的区分能力有限（c 指数分别为 0.531、0.545 和 0.525）。同时，7 版 II 期前列腺癌且 PSA 水平为 20ng/ml 或以上的患者 15 年生化无复发生存率（42.2% vs 58.8%）、无转移生存率（78.2% vs 88.8%）和癌症特异性生存率（88.0% vs 94.4%，均 p<0.001）明显低于 7 版 II 期前列腺癌且 PSA 水平<20ng/ml 的患者。然而，7 版 II 期前列腺癌且 PSA 水平为 20ng/ml 或以上的患者 15 年生化无复发生存率（42.2% vs 31.3%，p=0.007）、无转移生存率（78.2% vs 68.0%，p<0.001）和癌症特异性生存率（88.0% vs 83.4%，p=0.01）明显优于 7 版 III 期患者。此外，7 版 II 期前列腺癌且 Gleason 分级组为 5 的患者 15 年生化无复发生存率（37.1% vs 57.9%，p<0.001）、无转移生存率（63.8% vs 88.5%，p<0.001）和癌症特异性生存率（73.0% vs 94.3%，p<0.001）明显低于 7 版 II 期前列腺癌且 Gleason 分级组为 1-4 的患者，且癌症特异性生存率（73.0% vs 83.4%，p=0.005）也明显低于 7 版 III 期患者。
我们的数据支持 AJCC 分类的新变化。
