Kurbegovic Sorel, Berg Kasper Drimer, Thomsen Frederik Birkebæk, Gruschy Lisa, Iversen Peter, Brasso Klaus, Røder Martin Andreas
a Copenhagen Prostate Cancer Center, Department of Urology , Rigshospitalet Copenhagen University Hospital , Copenhagen N , Denmark.
Scand J Urol. 2017 Dec;51(6):450-456. doi: 10.1080/21681805.2017.1356369. Epub 2017 Aug 1.
To report oncological outcomes including biochemical recurrence (BR) following radical prostatectomy (RP) from a large consecutive cohort operated in an 18-year period. Additionally, an in-depth analysis of outcomes among D'Amico intermediate-risk patients is presented.
A total of 2,091 patients with PCa who underwent RP at Department of Urology, Rigshospitalet, Copenhagen, Denmark between 1995 and 2013 were included. Univariate and multiple cause-specific Cox regression analyses for BR were applied using competing risk models. Death prior to BR was considered a competing event. BR was defined as the first PSA ≥0.2 ng/ml. No patient received adjuvant therapy prior to BR.
Overall, the 5- and 10-years cumulative incidence of BR was 21.9% and 32.0%. The 10-year cumulative incidence of BR was 17.9%, 31.9% and 47.9% for D'Amico low-, intermediate- and high-risk patients, respectively. Among intermediate-risk patients, the 10-year cumulative incidence of BR was 24.0%, 39.9%, and 47.9% for patients harboring one, two or three risk factors, respectively (Gray test: p < 0.0001). In multivariate analysis, PSA, RP GS, pT category, and positive surgical margins were significantly associated with an increased risk of BR.
The risk of BR among patients with intermediate-risk disease is not uniform and is highly dependent on the number of risk factors per patient. Intermediate-risk patients have a comparable risk of recurrence as high-risk patients, and this should be taken into consideration when counseling patients prior to RP.
报告在18年期间连续接受手术的大量队列中，根治性前列腺切除术（RP）后包括生化复发（BR）在内的肿瘤学结局。此外，还对达米科中危患者的结局进行了深入分析。
纳入1995年至2013年期间在丹麦哥本哈根里格霍斯医院泌尿外科接受RP的2091例前列腺癌患者。使用竞争风险模型对BR进行单因素和多因素特定病因Cox回归分析。BR之前的死亡被视为竞争事件。BR定义为首次前列腺特异性抗原（PSA）≥0.2 ng/ml。在BR之前没有患者接受辅助治疗。
总体而言，BR的5年和10年累积发生率分别为21.9%和32.0%。达米科低危、中危和高危患者的BR 10年累积发生率分别为17.9%、31.9%和47.9%。在中危患者中，分别有1个、2个或3个风险因素的患者BR的10年累积发生率分别为24.0%、39.9%和47.9%（格雷检验：p＜0.0001）。在多变量分析中，PSA、RP Gleason评分（GS）、pT分类和手术切缘阳性与BR风险增加显著相关。
中危疾病患者的BR风险并不一致，且高度依赖于每位患者的风险因素数量。中危患者与高危患者有相当的复发风险，在RP前为患者提供咨询时应考虑到这一点。
