前列腺特异性抗原水平为50 ng/ml或更高的非转移性前列腺癌根治性前列腺切除术的肿瘤学及围手术期结局

Oncological and peri-surgical outcomes of radical prostatectomy for non-metastatic prostate cancer with prostate-specific antigen level of 50 ng/ml or greater.

作者信息

Makino Katsuhiro, Nakagawa Tohru, Ito Eisaku, Kasahara Ichiro, Murata Takashi, Fujimura Tetsuya, Fukuhara Hiroshi, Homma Yukio

机构信息

Department of Urology, Graduate School of Medicine, The University of Tokyo.

Department of Urology, Ome Municipal General Hospital.

出版信息

Jpn J Clin Oncol. 2018 May 1;48(5):485-490. doi: 10.1093/jjco/hyy044.

DOI:10.1093/jjco/hyy044

PMID:29635526

Abstract

BACKGROUND

The role of radical prostatectomy in treating non-metastatic prostate cancer patients with high prostate-specific antigen levels remains unclear. We evaluated the feasibility and oncological outcomes of radical prostatectomy in non-metastatic prostate cancer patients with prostate-specific antigen levels of 50 ng/ml or higher.

METHODS

This retrospective study included 31 patients who were diagnosed as very high-risk prostate cancer (clinical stage of any T, N0-1 M0 and PSA levels ≥50 ng/ml) and underwent radical prostatectomy either as a monotherapy or as a component of multimodal therapy (RP group). Surgery-related complications were investigated. Time to castration-resistant prostate cancer, cancer-specific survival, and overall survival were estimated using the Kaplan-Meier method. A total of 47 patients with very high-risk prostate cancer who were treated with androgen deprivation therapy without local therapy served as a control group (ADT group). Survivals were compared between RP group and ADT group in exploratory analyses.

RESULTS

The median pretreatment prostate-specific antigen was 87 ng/ml and 100 ng/ml in the RP and ADT groups, respectively (P = 0.67). Surgical complications of Clavien-Dindo Grade 3 were documented in nine patients (29%). Ten-year castration-resistant prostate cancer-free, cancer-specific and overall survivals were 78%, 81% and 77% in RP group, respectively, and they were significantly better than those of ADT group (54%, P = 0.006; 54%, P = 0.006 and 38%, P < 0.001). Exploratory multivariate analysis identified radical prostatectomy as the only significant factor associated with a better cancer-specific survival (hazard ratio: 0.25, P = 0.006).

CONCLUSIONS

Radical prostatectomy is feasible for non-metastatic prostate cancer patients with prostate-specific antigen levels of 50 ng/ml or higher. Radical prostatectomy is a viable option for select patients with non-metastatic, very high-risk prostate cancer.

摘要

背景

根治性前列腺切除术在治疗前列腺特异性抗原水平高的非转移性前列腺癌患者中的作用仍不明确。我们评估了根治性前列腺切除术在前列腺特异性抗原水平为50 ng/ml或更高的非转移性前列腺癌患者中的可行性和肿瘤学结局。

方法

这项回顾性研究纳入了31例被诊断为极高风险前列腺癌（任何T分期、N0 - 1 M0且前列腺特异性抗原水平≥50 ng/ml）的患者，他们接受了根治性前列腺切除术，作为单一疗法或多模式治疗的一部分（RP组）。对手术相关并发症进行了调查。使用Kaplan-Meier方法估计去势抵抗性前列腺癌的发生时间、癌症特异性生存率和总生存率。共有47例接受雄激素剥夺治疗而未进行局部治疗的极高风险前列腺癌患者作为对照组（ADT组）。在探索性分析中比较了RP组和ADT组的生存率。

结果

RP组和ADT组治疗前前列腺特异性抗原的中位数分别为87 ng/ml和100 ng/ml（P = 0.67）。9例患者（29%）记录有Clavien-Dindo 3级手术并发症。RP组10年无去势抵抗性前列腺癌生存率、癌症特异性生存率和总生存率分别为78%、81%和77%，均显著优于ADT组（分别为54%，P = 0.006；54%，P = 0.006和38%，P < 0.001）。探索性多变量分析确定根治性前列腺切除术是与更好的癌症特异性生存相关的唯一显著因素（风险比：0.25，P = 0.006）。