Song Wan, Lee Dong Hyeon, Jeon Hwang Gyun, Jeong Byong Chang, Seo Seong Il, Lee Hyun Moo, Choi Han Yong, Kim Jong Wook, Lee SangChul, Byun Seok-Soo, Jeong Chang Wook, Kwak Cheol, Cho Jin Seon, Ahn Hanjong, Jeon Seong Soo
Department of Urology, School of Medicine, Ewha Womans University, Seoul, Korea.
Department of Urology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea.
J Cancer Res Clin Oncol. 2017 Nov;143(11):2393-2400. doi: 10.1007/s00432-017-2502-7. Epub 2017 Aug 19.
Oncologic outcomes of patients with pT3aN0/Nx prostate cancer (PCa) with positive surgical margins (PSM) after radical prostatectomy (RP) are heterogeneous. We investigated the impact of Gleason score (GS) on biochemical recurrence (BCR) in these patients.
A retrospective, multicenter study was performed on 795 patients with pT3aN0/Nx PCa with PSM after RP between January 2006 and December 2014. Clinicopathologic characteristics of patients were examined and onset of BCR was identified. Kaplan-Meier survival analysis was used to illustrate BCR-free survival (BFS) and Cox proportional hazard models were applied to identify factors predicting BCR.
During the mean follow-up period of 63.9 months, BCR was identified in 274 (34.5%) patients. The 5-year BFS was 56.6% in all patients. In multivariate analysis, pathologic GS was the only significant prognostic factor for BCR in patients with pT3aN0/Nx PCa with PSM (GS 6 vs. GS 7 (3 + 4), P = 0.047; vs. GS 7 (4 + 3), P = 0.007, and vs. GS 8-10, P < 0.001). When patients were stratified according to GS, 5-year BFS was 78.6% in GS 6, 66.2% in GS 7 (3 + 4), 51.1% in GS 7 (4 + 3) and 35.5% in GS 8-10.
In patients with pT3aN0/Nx with PSM after RP, pathologic GS is the sole independent predictor for risk stratification of BCR. These findings might be used to determine the risk and timing of BCR and to help counsel patients regarding treatment strategy and prognosis of disease on an individual basis.
接受根治性前列腺切除术（RP）后手术切缘阳性（PSM）的pT3aN0/Nx前列腺癌（PCa）患者的肿瘤学结局存在异质性。我们研究了 Gleason评分（GS）对这些患者生化复发（BCR）的影响。
对2006年1月至2014年12月期间795例接受RP后出现PSM的pT3aN0/Nx PCa患者进行了一项回顾性多中心研究。检查患者的临床病理特征并确定BCR的发生情况。采用Kaplan-Meier生存分析来描述无生化复发生存（BFS）情况，并应用Cox比例风险模型来确定预测BCR的因素。
在平均63.9个月的随访期内，274例（34.5%）患者出现了BCR。所有患者的5年BFS为56.6%。在多变量分析中，病理GS是接受RP后出现PSM的pT3aN0/Nx PCa患者BCR的唯一显著预后因素（GS 6与GS 7（3+4）相比，P=0.047；与GS 7（4+3）相比，P=0.007，与GS 8-10相比，P<0.001）。当根据GS对患者进行分层时，GS 6患者的5年BFS为78.6%，GS 7（3+4）患者为66.2%，GS 7（4+3）患者为51.1%，GS 8-10患者为35.5%。
对于接受RP后出现PSM的pT3aN0/Nx患者，病理GS是BCR风险分层的唯一独立预测因素。这些发现可用于确定BCR的风险和时间，并有助于就疾病的治疗策略和预后为患者提供个体化的咨询。
