[前列腺活检至根治性前列腺切除术的延迟会影响生化复发风险吗？]
[Does the delay from prostate biopsy to radical prostatectomy influence the risk of biochemical recurrence?].
作者信息
Meunier M E, Neuzillet Y, Radulescu C, Cherbonnier C, Hervé J-M, Rouanne M, Molinié V, Lebret T
机构信息
Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France.
Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
出版信息
Prog Urol. 2018 Sep;28(10):475-481. doi: 10.1016/j.purol.2018.05.003. Epub 2018 Jun 12.
INTRODUCTION
The influence of the delay between prostate biopsy and radical prostatectomy for patients with localized prostate cancer is controversial. The objective of this study was to establish a time limit between prostate biopsy and radical prostatectomy beyond which the risks of upgradging and biochemical recurrence (BCR) are increased.
MATERIAL AND METHODS
Between January 2013 and January 2017, a retrospective analysis of the clinical, biological and histological data of 513 patients treated with radical prostatectomy for localized prostate cancer was performed in a single center. The primary endpoint was the assessment of the risk of BCR by the difference between post-biopsy USCF-CAPRA and post-surgical CAPRA-S scores. The secondary endpoint was the evaluation of the upgrading by the difference between the Gleason score on biopsy and on surgical specimen. The risks of BCR and upgrading were compared by Student test according to different delays between prostate biopsy and radical prostatectomy. The shortest delays for which a significant difference was found were reported.
RESULTS
In this study, 513 patients were included. The median age at the time of the biopsy was 65 years (IQR: 60-69). The median preoperative PSA was 7.30ng/mL (IQR: 5.60-9.94). The median time between biopsy and surgery was 108 days (IQR: 86-141). For the entire cohort, the risk of BCR was significantly higher above a threshold of 90 days (P=0.039). No threshold was found for Gleason 6(3+3) patients. A 90-day threshold was found for Gleason 7(3+4) patients (P=0.038). Gleason patients≥8 had more upgrading beyond a 60-day threshold (P=0.040).
CONCLUSION
Our study showed that after a 3 months delay, the risk of BCR was significantly higher for localized prostate cancer. It seemed possible to extend this period for low-risk patients, whereas it seemed necessary to keep it for intermediate-risks and to reduce it to 2 months for high-risks.
LEVEL OF EVIDENCE
引言
对于局限性前列腺癌患者，前列腺活检与根治性前列腺切除术之间延迟的影响存在争议。本研究的目的是确定前列腺活检与根治性前列腺切除术之间的时间限制，超过该时间限制，肿瘤升级和生化复发（BCR）的风险会增加。
材料与方法
2013年1月至2017年1月期间，在单一中心对513例行根治性前列腺切除术治疗局限性前列腺癌患者的临床、生物学和组织学数据进行回顾性分析。主要终点是通过活检后USCF-CAPRA与术后CAPRA-S评分的差异评估BCR风险。次要终点是通过活检时和手术标本上的Gleason评分差异评估肿瘤升级情况。根据前列腺活检与根治性前列腺切除术之间的不同延迟时间，采用学生检验比较BCR和肿瘤升级的风险。报告发现有显著差异的最短延迟时间。
结果
本研究纳入513例患者。活检时的中位年龄为65岁（四分位间距：60 - 69岁）。术前中位PSA为7.30ng/mL（四分位间距：5.60 - 9.94）。活检与手术之间的中位时间为108天（四分位间距：86 - 141天）。对于整个队列，在90天的阈值以上，BCR风险显著更高（P = 0.039）。对于Gleason 6(3 + 3)患者未发现阈值。对于Gleason 7(3 + 4)患者发现90天的阈值（P = 0.038）。Gleason评分≥8的患者在60天的阈值以上有更多肿瘤升级情况（P = 0.040）。
结论
我们的研究表明，延迟3个月后，局限性前列腺癌患者的BCR风险显著更高。对于低风险患者，似乎有可能延长这段时间，而对于中风险患者似乎有必要维持该时间，对于高风险患者则应缩短至2个月。
证据水平
4级。
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