Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, University of Bern, Bern, Switzerland.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2018 Jun;199(6):1502-1509. doi: 10.1016/j.juro.2017.12.056. Epub 2018 Jan 4.
We tested the latest update in the prostate cancer staging system by assessing the prognostic association of pT2 subclassification with the probability of survival related outcomes in patients who underwent radical prostatectomy.
We retrospectively analyzed the records of a total of 15,305 patients who underwent radical prostatectomy at 2 referral centers between 1985 and 2016, and had pT2 disease at the final pathological evaluation. Descriptive statistics were used to compare baseline data stratified by pT2 substages (pT2a/b vs pT2c). Cox regression models were adjusted for institution analyzed differences in the rate of biochemical recurrence, metastasis, cancer specific death and overall mortality. Multivariable Cox regression models were used to evaluate the predictive value of pT2 subclassification for survival, including the linear predictor from the Stephenson nomogram.
Prostate specific antigen levels and Gleason score differed significantly between the pT2 substages (each p <0.0001). At a median followup of 6.0 years (IQR 3.3-10.1) 2,083 patients had biochemical recurrence, 161 had metastases, 43 had died of prostate cancer and 1,032 had died of another cause. On univariate analysis the pT2 subclassification was significantly associated with biochemical recurrence (p = 0.001) and distant metastasis (p = 0.033) but not with cancer specific death (p = 0.6) or overall mortality (p = 0.3). Multivariable analysis showed no evidence of a significant association between the pT2 subclassification and biochemical recurrence (p = 0.4) or distant metastasis (p = 0.6). Multivariable analysis of cancer specific death and overall mortality was omitted due to lack of significance on univariate analysis.
Subclassification of pT2 prostate cancer is not a prognostic indicator of survival related outcomes after radical prostatectomy. Our results validate the elimination of pT2 substages in the updated staging system.
我们通过评估接受根治性前列腺切除术的患者中 pT2 亚分期与生存相关结局概率之间的预后相关性，来检验前列腺癌分期系统的最新更新。
我们回顾性分析了 1985 年至 2016 年在 2 个转诊中心接受根治性前列腺切除术且最终病理评估为 pT2 疾病的 15305 例患者的记录。使用描述性统计方法比较按 pT2 亚分期（pT2a/b 与 pT2c）分层的基线数据。在 Cox 回归模型中调整了机构分析的生化复发、转移、癌症特异性死亡和总死亡率的差异。多变量 Cox 回归模型用于评估 pT2 亚分期对生存的预测价值，包括 Stephenson 列线图的线性预测值。
前列腺特异性抗原水平和 Gleason 评分在 pT2 亚分期之间差异显著（均 p<0.0001）。在中位随访 6.0 年（IQR 3.3-10.1）时，2083 例患者发生生化复发，161 例患者发生转移，43 例患者死于前列腺癌，1032 例患者死于其他原因。单变量分析显示，pT2 亚分期与生化复发（p=0.001）和远处转移（p=0.033）显著相关，但与癌症特异性死亡（p=0.6）或总死亡率（p=0.3）无关。多变量分析显示，pT2 亚分期与生化复发（p=0.4）或远处转移（p=0.6）无显著相关性。由于单变量分析无显著性，癌症特异性死亡和总死亡率的多变量分析被省略。
pT2 前列腺癌的亚分期不是根治性前列腺切除术后生存相关结局的预后指标。我们的结果验证了在更新的分期系统中消除 pT2 亚分期的合理性。
