Department of Urology, Institute Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
Laboratory of Physical Properties, School of Agricultural, Food and Biosystems Engineering, Technical University of Madrid, Madrid, Spain.
Int J Urol. 2019 Jul;26(7):725-730. doi: 10.1111/iju.13982. Epub 2019 Apr 18.
To estimate the conditional biochemical recurrence-free probability and to develop a predictive model according to the disease-free interval for men with clinically localized prostate cancer treated with minimally invasive radical prostatectomy.
The study population consisted of 3576 consecutive patients who underwent laparoscopic radical prostatectomy and 2619 men treated with robotic radical prostatectomy in the past 15 years at Institute Mutualiste Montsouris, Paris, France. Biochemical recurrence was defined as serum prostate-specific antigen ≥0.2 ng/dL. Univariable and multivariable survival analyses were carried out to identify the prognostic factors for overall free-of-biochemical recurrence probability and conditional survival with respect to the years from surgery without recurrence. A detailed nomogram for the static and dynamic prognosis of biochemical recurrence was developed and internally validated.
The median follow-up period was 8.49 years (interquartile range 4.01-12.97), and 1148 (19%) patients experienced biochemical recurrence. Significant variables associated with biochemical recurrence in the multivariable model included preoperative prostate-specific antigen, positive surgical margins, extracapsular extension, pathological Gleason ≥4 + 3 and laparoscopic surgery (all P < 0.001). Conditional survival probability decreased with increasing time without biochemical recurrence from surgery. When stratified by prognosis factors, the 5- and 10-year conditional survival improved in all cases, especially in men with worse prognosis factors. The concordance index of the nomogram was 0.705.
Conditional survival provides relevant information on how prognosis evolves over time. The risk of recurrence decreases with increasing number of years without disease. An easy-to-use nomogram for conditional survival estimates can be useful for patient counseling and also to optimize postoperative follow-up strategies.
根据无病间期估计局限性前列腺癌患者接受微创根治性前列腺切除术治疗后的条件生化无复发生存率，并建立预测模型。
本研究纳入了法国巴黎蒙苏里互助协会研究所过去 15 年中接受腹腔镜根治性前列腺切除术的 3576 例连续患者和 2619 例接受机器人根治性前列腺切除术的患者。生化复发定义为血清前列腺特异性抗原≥0.2ng/dL。进行单变量和多变量生存分析，以确定总生化无复发生存率和与无复发手术年限相关的条件生存的预后因素。开发了详细的列线图，用于预测生化复发的静态和动态预后，并进行了内部验证。
中位随访时间为 8.49 年（四分位间距 4.01-12.97），1148 例（19%）患者发生生化复发。多变量模型中与生化复发相关的显著变量包括术前前列腺特异性抗原、阳性手术切缘、包膜外延伸、病理 Gleason≥4+3 和腹腔镜手术（均 P<0.001）。随着无生化复发手术时间的增加，条件生存概率降低。根据预后因素分层时，所有情况下的 5 年和 10 年条件生存均有所改善，尤其是预后因素较差的患者。列线图的一致性指数为 0.705。
条件生存提供了有关预后随时间变化的相关信息。无病时间越长，复发风险越低。用于条件生存估计的易于使用的列线图可用于患者咨询，也可优化术后随访策略。
