Nkengurutse Gerard, Tian Feng, Jiang Sixiong, Wang Qi, Wang Ying, Sun Weibing
Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
Front Oncol. 2020 Sep 10;10:1761. doi: 10.3389/fonc.2020.01761. eCollection 2020.
D'Amico high-risk prostate cancer (Pca) patients experience poor and heterogeneous oncological outcomes. This heterogeneity highlights a need to extensively explore factors associated with poor outcomes to guide decision-making. To assess predictors of biochemical recurrence (BCR)-free survival in high-risk patients following radical prostatectomy (RP), and subsequently establish a model predicting outcomes. We retrospectively identified D'Amico high-risk non-metastatic Pca patients who underwent RP between 2013 and 2019 in our hospital. We collected data including PSA level, clinical stage, biopsy Gleason score (GS), number of D'Amico high-risk factors (RF), the inflammatory status (Neutrophil-to-lymphocyte ratio [NLR], derived NLR [dNLR], platelet-to-lymphocyte ratio [PLR] and LDH). Kaplan-Meier methods were used to analyze BCR-free survival. Univariate and multivariate analyses were performed using Cox proportional hazards model to evaluate the association between clinicopathological parameters and BCR-free survival. The median follow-up time for the 101 patients' cohort was 26 months (range: 3-81 months). The number of RF (1RF vs. ≥2RF), biopsy GS (<8 vs. ≥8), clinical stage (≤cT2c vs. >cT2c), pathological stage, and the presence of adverse pathological features were significant predictors of BCR ( < 0.05). Other parameters including inflammatory status (dNLR, NLR, PLR, and LDH) were not of predictive value. On multivariable analysis, biopsy GS (<8 vs. ≥8; HR 2.439) and clinical stage (≤cT2c vs. >cT2c; HR 3.271) were the independent predictors of BCR. Based on these two independent predictors, patients were stratified into three risk subgroups: favorable (0 risk factor; 47% of patients), intermediate (1 risk factor; 42 %), unfavorable (2 risk factors; 11%). The intermediate and unfavorable subgroups have a significantly shorter median BCR-free survival compared to the favorable subgroup ( < 0.001). Several factors are associated with BCR. Clinical stage (≤cT2c vs. >cT2c) and biopsy GS (<8 vs. ≥8) are the independent predictors of BCR. The stratification of high-risk patients into risk subgroups based on these two predictors shows that the intermediate and unfavorable subgroups have a significantly shorter median BCR-free survival compared to the favorable subgroup. The preoperative stratification model may help urologists and patients during decision-making. In non-metastatic high-risk patients, preoperative inflammatory markers (NLR, dNLR, PLR, and LDH) are not of prognostic value.
达米科高危前列腺癌（Pca）患者的肿瘤学结局较差且存在异质性。这种异质性凸显了广泛探索与不良结局相关因素以指导决策的必要性。为了评估高危患者根治性前列腺切除术（RP）后无生化复发（BCR）生存期的预测因素，并随后建立一个预测结局的模型。我们回顾性地确定了2013年至2019年在我院接受RP的达米科高危非转移性Pca患者。我们收集了包括前列腺特异抗原（PSA）水平、临床分期、活检 Gleason评分（GS）、达米科高危因素（RF）数量、炎症状态（中性粒细胞与淋巴细胞比值[NLR]、衍生NLR [dNLR]、血小板与淋巴细胞比值[PLR]和乳酸脱氢酶[LDH]）等数据。采用Kaplan-Meier方法分析无BCR生存期。使用Cox比例风险模型进行单因素和多因素分析，以评估临床病理参数与无BCR生存期之间的关联。101例患者队列的中位随访时间为26个月（范围：3 - 81个月）。RF数量（1个RF与≥2个RF）、活检GS（<8与≥8）、临床分期（≤cT2c与>cT2c）、病理分期以及不良病理特征的存在是BCR的显著预测因素（<0.05）。其他参数包括炎症状态（dNLR、NLR、PLR和LDH）无预测价值。在多因素分析中，活检GS（<8与≥8；风险比[HR] 2.439）和临床分期（≤cT2c与>cT2c；HR 3.271）是BCR的独立预测因素。基于这两个独立预测因素，患者被分为三个风险亚组：有利（0个风险因素；47%的患者）、中等（1个风险因素；42%）、不利（2个风险因素；11%）。与有利亚组相比，中等和不利亚组的无BCR生存期的中位时间显著缩短（<0.001）。几个因素与BCR相关。临床分期（≤cT2c与>cT2c）和活检GS（<8与≥8）是BCR的独立预测因素。基于这两个预测因素将高危患者分层为风险亚组表明，与有利亚组相比，中等和不利亚组的无BCR生存期的中位时间显著缩短。术前分层模型可能有助于泌尿外科医生和患者进行决策。在非转移性高危患者中，术前炎症标志物（NLR、dNLR、PLR和LDH）无预后价值。
