Bijalwan Priyank, Pooleri Ginil Kumar, Kalavampara Sanjeevan V, Bhat Sanjay, Thomas Appu, Sundar Praveen, Laddha Abhishek
Division of Uro-Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Indian J Urol. 2018 Oct-Dec;34(4):260-267. doi: 10.4103/iju.IJU_65_18.
We analyzed the biochemical recurrence-free survival (BRFS) of patients with high-risk prostate cancer (HRCaP) as per the D'Amico classification undergoing radical prostatectomy (RP) at our center. We aimed to determine whether the number and type of risk factors (cT2c-T3b, prostate-specific antigen >20 ng/ml, Gleason score >7) are associated with biochemical recurrence (BCR) in HRCaP patients undergoing RP in the Indian population.
Between 2006 and 2017, 192 patients underwent RP (open RP [ORP], laparoscopic RP [LRP], and robotic RP [RRP]) at our center, of which 109 had D'Amico HR disease. Preoperative, postoperative, and pathological outcome data were analyzed for patients with HR disease as per the D'Amico classification. Subgroups were formed to determine whether an increasing number of risk factors (1, 2, or 3) were associated with poorer oncological results and early BCR. The Kaplan-Meier method with log-rank test was used to test the difference in BRFS between the groups. Univariate and multivariate analyses were done to find significant variable against BCR.
According to the D'Amico criteria, 109 patients had HR, 63 patients had intermediate-risk, and 19 patients had low-risk disease. These 109 patients with HR disease were analyzed in our study (50 RRP, 33 ORP, and 26 LRP). A total of 59 (54.1%) patients had one HR factor (1HR), 44 (40%) had two HR factors (2HR), and 6 (5.5%) had three HR factors (3HR). The mean follow-up for our patient population was 21.5 ± 19 months (median 18 months; range, 0-108). Overall, the 2-year and 5-year BRFS was 45% and 35%, respectively (mean BRFS 46 ± 6 months). Two-year BRFS was 63%, 23%, and 22%, respectively, for 1HR, 2HR, and 3HR (logrank, < 0.0001). The prognostic substratification based on the three risk factors was significantly predictive for adverse pathologic features and oncologic outcomes.
Substratification based on the three well-defined criteria leads to a better identification of the more aggressive cancers and prediction of need for additional treatment modalities. Localized HRCaP includes a heterogeneous population of patients with variable oncological outcomes.
我们分析了在我院接受根治性前列腺切除术（RP）的按照达米科分类法划分的高危前列腺癌（HRCaP）患者的无生化复发生存期（BRFS）。我们旨在确定风险因素（cT2c - T3b、前列腺特异性抗原>20 ng/ml、 Gleason评分>7）的数量和类型是否与印度人群中接受RP的HRCaP患者的生化复发（BCR）相关。
2006年至2017年间，192例患者在我院接受了RP（开放RP[ORP]、腹腔镜RP[LRP]和机器人辅助RP[RRP]），其中109例患有达米科高危疾病。按照达米科分类法对高危疾病患者的术前、术后和病理结果数据进行了分析。形成亚组以确定风险因素数量增加（1个、2个或3个）是否与更差的肿瘤学结果和早期BCR相关。采用带有对数秩检验的Kaplan - Meier方法来检验各组之间BRFS的差异。进行单因素和多因素分析以找出与BCR相关的显著变量。
根据达米科标准，109例患者为高危，63例患者为中危，19例患者为低危疾病。在我们的研究中对这109例高危疾病患者进行了分析（50例RRP，33例ORP，26例LRP）。共有59例（54.1%）患者有一个高危因素（1HR），44例（40%）有两个高危因素（2HR），6例（5.5%）有三个高危因素（3HR）。我们患者群体的平均随访时间为21.5±19个月（中位数18个月；范围，0 - 108个月）。总体而言，2年和5年的BRFS分别为45%和35%（平均BRFS为46±6个月）。1HR、2HR和3HR的2年BRFS分别为63%、23%和22%（对数秩检验，<0.0001）。基于这三个风险因素的预后分层对于不良病理特征和肿瘤学结果具有显著的预测性。
基于三个明确标准的分层能够更好地识别侵袭性更强的癌症，并预测是否需要额外的治疗方式。局限性HRCaP包括一群具有不同肿瘤学结果的异质性患者。
