Park Jee Soo, Koo Kyo Chul, Choi In Young, Lee Ji Youl, Hong Jun Hyuk, Kim Choung-Soo, Lee Hyun Moo, Hong Sung Kyu, Byun Seok-Soo, Rha Koon Ho, Chung Byung Ha, Lee Kwang Suk
Department of Urology, Yonsei University College of Medicine.
Graduate School of Management and Policy, Catholic University.
Medicine (Baltimore). 2019 Nov;98(45):e17931. doi: 10.1097/MD.0000000000017931.
When making clinical decisions concerning additional treatment for patients who have undergone radical prostatectomy (RP), adverse laboratory/pathological features are considered major factors. We investigated and compared the prognostic efficacy of adverse laboratory/pathological features in predicting overall survival (OS) and biochemical failure (BCF) in these patients.The Korean Prostate Cancer Database was used to identify patients undergoing RP between May 2001 and April 2013. Patients with incomplete clinicopathological data or positive lymphadenectomy results were excluded. Finally, 4486 patients included in the final analysis were categorized based on their adverse laboratory/pathological features.Adverse pathological features and detectable prostate-specific antigen (PSA) levels 6 weeks after surgery were observed in 1977 (44.1%) and 634 (14.1%) patients, respectively. PSA levels, pathological Gleason score ≥8, adverse pathological features [positive surgical margin (PSM), seminal vesicle invasion (SVI), and extracapsular extension (ECE)], and adverse laboratory features (detectable PSA levels after 6 weeks) together were significant predictors of BCF-free survival (BCFFS). SVI was identified as a predictor of OS. Additionally, patients with ECE, PSM, and detectable PSA levels after 6 weeks, but without SVI, showed similar OS to those without ECE, PSM, and detectable PSA levels after 6 weeks and with SVI (log-rank test, P = .976).We successfully stratified patients based on adverse laboratory/pathological features after RP and demonstrated that these are important prognostic factors for OS and BCFFS. Additionally, we identified the criteria for selecting appropriate patients for undergoing additional treatment based on OS and BCFFS.
在为接受根治性前列腺切除术（RP）的患者制定关于额外治疗的临床决策时，不良实验室/病理特征被视为主要因素。我们调查并比较了不良实验室/病理特征在预测这些患者总生存期（OS）和生化复发（BCF）方面的预后效果。利用韩国前列腺癌数据库识别出2001年5月至2013年4月期间接受RP的患者。排除临床病理数据不完整或淋巴结清扫结果为阳性的患者。最终，纳入最终分析的4486例患者根据其不良实验室/病理特征进行分类。分别在1977例（44.1%）和634例（14.1%）患者中观察到不良病理特征和术后6周可检测到的前列腺特异性抗原（PSA）水平。PSA水平、病理Gleason评分≥8、不良病理特征[手术切缘阳性（PSM）、精囊侵犯（SVI）和包膜外扩展（ECE）]以及不良实验室特征（术后6周可检测到的PSA水平）共同是无生化复发生存期（BCFFS）的显著预测因素。SVI被确定为OS的预测因素。此外，有ECE、PSM和术后6周可检测到的PSA水平但无SVI的患者，其OS与无ECE、PSM和术后6周可检测到的PSA水平且有SVI的患者相似（对数秩检验，P = 0.976）。我们成功地根据RP术后的不良实验室/病理特征对患者进行了分层，并证明这些是OS和BCFFS的重要预后因素。此外，我们确定了基于OS和BCFFS选择合适患者进行额外治疗的标准。
