Oncol Res Treat. 2017;40(9):508-514. doi: 10.1159/000477545. Epub 2017 Aug 10.
The aim of this study was to clarify and examine the outcomes of prostate cancer patients classified as intermediate risk (IR) using the D'Amico risk classification system, specifically focusing on the influence of primary and secondary biopsy Gleason score (BGS).
An institutional review board-approved database of robotic-assisted radical prostatectomies performed after 2006 was stratified by standard D'Amico criteria. IR patients were then sub-stratified by BGS. Pathologic and intermediate-term biochemical disease-free survival (BDFS) outcomes were analyzed.
Overall, 1,090 patients were classified as D'Amico low-risk, 896 as IR, and 240 as high-risk. Of the 896 IR patients, 63 had BGS 6, 630 were 3 + 4 = 7, and 203 4 + 3 = 7. Among IR patients, as the BGS increased, there was an increasing likelihood of extracapsular extension (21, 28, and 38%, respectively; p = 0.005), positive surgical margins (14, 26, 31%; p = 0.048), and worse 3-year BDFS (96, 94, 88%; p = 0.01). Multivariable logistic regression and Cox regression analyses confirmed differences among IR groups.
D'Amico IR patients demonstrate significant heterogeneity in both pathologic outcomes and BDFS. IR patients with a BGS of 6 appear to have similar intermediate-term BDFS as low-risk patients. An increasing BGS from 3 + 3 to 3 + 4 to 4 + 3 results in a higher likelihood of locally-advanced disease and intermediate-term biochemical failure.
本研究旨在阐明并检验采用 D'Amico 风险分类系统分类为中危（IR）的前列腺癌患者的结局，特别关注原发和次要活检 Gleason 评分（BGS）的影响。
一项经机构审查委员会批准的、于 2006 年后行机器人辅助根治性前列腺切除术的数据库，按照标准 D'Amico 标准进行分层。然后，根据 BGS 将 IR 患者进一步分层。分析病理和中期生化无病生存（BDFS）结局。
总体而言，1090 例患者被分类为 D'Amico 低危，896 例为 IR，240 例为高危。在 896 例 IR 患者中，63 例为 BGS 6，630 例为 3+4=7，203 例为 4+3=7。在 IR 患者中，随着 BGS 的增加，发生包膜外延伸的可能性逐渐增加（分别为 21%、28%和 38%；p=0.005）、阳性手术切缘（14%、26%、31%；p=0.048）和较差的 3 年 BDFS（96%、94%、88%；p=0.01）。多变量逻辑回归和 Cox 回归分析证实了 IR 组之间的差异。
D'Amico IR 患者在病理结局和 BDFS 方面存在显著异质性。BGS 为 6 的 IR 患者似乎具有与低危患者相似的中期 BDFS。BGS 从 3+3 增加到 3+4 再增加到 4+3，会导致局部进展性疾病和中期生化失败的可能性增加。
