Kato Masashi, Kimura Kyosuke, Hirakawa Akihiro, Kobayashi Yumiko, Ishida Ryo, Kamihira Osamu, Majima Tsuyoshi, Funahashi Yasuhito, Sassa Naoto, Matsukawa Yoshihisa, Hattori Ryohei, Gotoh Momokazu, Tsuzuki Toyonori
Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Urology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
Prostate. 2018 Jan;78(1):11-16. doi: 10.1002/pros.23438. Epub 2017 Nov 2.
High-risk prostate cancer can be defined by a patient's Gleason score (GS), prostate-specific antigen (PSA) level, and clinical T (cT) stage, but a novel marker is needed due to heterogeneity of the disease. In this study, we evaluated whether intraductal carcinoma of the prostate (IDC-P) confirmed by needle biopsy is an adverse prognostic parameter for progression-free survival (PFS) and cancer-specific survival (CSS) in patients with high-risk prostate cancer.
We retrospectively evaluated 204 patients with high-risk prostate cancer treated by radical prostatectomy from 1991 to 2005 at Nagoya University and its affiliated hospitals. Data on each patient's PSA level, biopsy GS, cT stage, presence of Gleason pattern 5, presence of IDC-P, percentage of the core involved with cancer, and maximum percentage of the core involved with cancer were analyzed.
The median follow-up period was 108 months (range, 11-257 months). Forty-eight patients (24%) showed disease progression. Thirty-four patients (17%) died of the disease during follow-up. The IDC-P component was detected in 74 (36%) needle biopsy samples. The 5-, 10-, and 15-year CSS rates of the IDC-P-negative cases were 3.2%, 9.0%, and 23.7%; the corresponding rates of the IDC-P-positive cases were 23.9%, 33.7%, and 52.7%, respectively (P = 0.0001). In the Fine and Gray's model for PFS, IDC-P, maximum percentage of the core involved with cancer, and cT stage were significantly associated (P = 0.013, P = 0.003, P = 0.007). In the Fine and Gray's model for CSS, only IDC-P was significant (P = 0.027). In a multivariate Cox regression analysis, IDC-P (P = 0.04; hazard ratio [HR], 1.95) and maximum percentage of the core involved with cancer (P = 0.021; HR, 0.43) were significant factors in predicting overall survival (OS).
The presence of IDC-P in a needle biopsy was a prognostic factor for PFS, CSS, and OS in patients with high-risk prostate cancer who underwent radical prostatectomy. Multimodal pre-and/or post- surgical therapy may be needed when IDC-P is found in a needle biopsy specimen.
高危前列腺癌可通过患者的 Gleason 评分（GS）、前列腺特异性抗原（PSA）水平和临床 T（cT）分期来定义，但由于该疾病的异质性，需要一种新的标志物。在本研究中，我们评估了经穿刺活检确诊的前列腺导管内癌（IDC-P）是否是高危前列腺癌患者无进展生存期（PFS）和癌症特异性生存期（CSS）的不良预后参数。
我们回顾性评估了 1991 年至 2005 年在名古屋大学及其附属医院接受根治性前列腺切除术的 204 例高危前列腺癌患者。分析了每位患者的 PSA 水平、活检 GS、cT 分期、Gleason 5 级模式的存在、IDC-P 的存在、癌累及核心的百分比以及癌累及核心的最大百分比的数据。
中位随访期为 108 个月（范围 11 - 257 个月）。48 例患者（24%）出现疾病进展。34 例患者（17%）在随访期间死于该疾病。在 74 份（36%）穿刺活检样本中检测到 IDC-P 成分。IDC-P 阴性病例的 5 年、10 年和 15 年 CSS 率分别为 3.2%、9.0%和 23.7%；IDC-P 阳性病例的相应比率分别为 23.9%、33.7%和 52.7%（P = 0.0001）。在用于 PFS 的 Fine 和 Gray 模型中，IDC-P、癌累及核心的最大百分比和 cT 分期显著相关（P = 0.013，P = 0.003，P = 0.007）。在用于 CSS 的 Fine 和 Gray 模型中，只有 IDC-P 具有显著性（P = 0.027）。在多变量 Cox 回归分析中，IDC-P（P = 0.04；风险比[HR]，1.95）和癌累及核心的最大百分比（P = 0.021；HR，0.43）是预测总生存期（OS）的显著因素。
穿刺活检中存在 IDC-P 是接受根治性前列腺切除术的高危前列腺癌患者 PFS、CSS 和 OS 的预后因素。当在穿刺活检标本中发现 IDC-P 时，可能需要多模式的术前和/或术后治疗。
