Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5118, USA.
Department of Urology, Prostate Center, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
World J Urol. 2021 May;39(5):1499-1507. doi: 10.1007/s00345-020-03323-8. Epub 2020 Jun 26.
The previous attempts for pT2 substaging of prostate cancer (PCa) were insufficient in providing prognostic subgroups and the search for new prognostic parameters to subcategorize pT2 PCa is, therefore, needed. Therefore, the current study investigated the association between tumor distribution patterns and the biochemical recurrence (BCR)-free survival rate in pT2pN0R0 PCa.
Following radical prostatectomy, the anatomical distribution of PCa in 743 men with pT1-pT3pN0 disease was analyzed to determine 20 types of PCa distribution patterns. Then, 245 men with pT2pN0R0 PCa was considered for prognostic evaluation with a mean follow-up period of 60 months. The spatial distribution patterns of PCa were evaluated using a cMDX-based map model of the prostate. An analysis including 552,049 comparison operations was performed to assist in the evaluation of the similarity levels of the distribution patterns. A k-mean cluster analysis was applied to determine groups with similar distribution patterns. A decision-tree analysis was performed to divide these groups according to frequency of BCR. The BCR-free survival rate was analyzed using Kaplan-Meier curves. Predictors of progression were investigated using a Cox proportional hazards model.
BCR occurred in 8.2% of the 245 men with pT2pN0R0 PCa. The median time of recurrence was 60 months (interquartile range [IQR]: 42-77). In univariate and multivariate analyses, the prostate volume and the distribution patterns were independent predictors for BCR, whereas the sub-staging of pT2 tumors, Gleason grading, prostate-specific antigen (PSA) level, and relative tumor volume were not. In the patients with pT2pN0R0 disease, PCa distribution patterns with the apical involvement were significantly associated with the risk of BCR (P = 0.001).
The spread tumor patterns with the apical involvement are associated with a high-risk of BCR in the pT2 tumor stage. The vertical tumor spread could be considered in developing improved prognostic pT2 sub-categories.
之前对前列腺癌（PCa）的 pT2 亚分期尝试不足，无法提供预后亚组，因此需要寻找新的预后参数来对 pT2 PCa 进行分类。因此，本研究调查了 pT2pN0R0 PCa 中肿瘤分布模式与生化复发（BCR）无复发生存率之间的关系。
在根治性前列腺切除术后，分析了 743 名 pT1-pT3pN0 疾病男性的 PCa 解剖分布，以确定 20 种 PCa 分布模式。然后，对 245 名 pT2pN0R0 PCa 患者进行了预后评估，中位随访时间为 60 个月。使用前列腺 cMDX 基于地图模型评估 PCa 的空间分布模式。进行了包括 552,049 次比较操作的分析，以协助评估分布模式的相似性水平。应用 k-均值聚类分析确定具有相似分布模式的组。应用决策树分析根据 BCR 的频率对这些组进行划分。使用 Kaplan-Meier 曲线分析 BCR 无复发生存率。使用 Cox 比例风险模型研究进展的预测因子。
在 245 名 pT2pN0R0 PCa 患者中，有 8.2%发生 BCR。中位复发时间为 60 个月（四分位距 [IQR]：42-77）。在单变量和多变量分析中，前列腺体积和分布模式是 BCR 的独立预测因子，而 pT2 肿瘤的亚分期、Gleason 分级、前列腺特异性抗原（PSA）水平和相对肿瘤体积则不是。在 pT2pN0R0 疾病患者中，具有 apical 受累的 PCa 分布模式与 BCR 风险显著相关（P=0.001）。
在 pT2 肿瘤分期中，具有 apical 受累的肿瘤扩散模式与 BCR 的高风险相关。垂直肿瘤扩散可考虑用于开发改进的预后 pT2 亚分类。
