Park Sung-Woo, Hwang Dae Sung, Song Won Hoon, Nam Jong Kil, Lee Hyun Jung, Chung Moon Kee
Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Urology, Pusan National University, Pusan, Korea.
Prostate Int. 2020 Dec;8(4):173-177. doi: 10.1016/j.prnil.2020.07.004. Epub 2020 Aug 6.
Conditional survival is defined as the likelihood of subsequent survival given the precondition of having already survived a certain length of time. Most analyses of conditional survival in prostate cancer are not clinically applicable because they do not analyze outcomes conditioned on the durability of cure after treatment. We evaluated the conditional probability of biochemical recurrence (BCR)-free survival (C-BCRFS) after radical prostatectomy (RP) for prostate cancer according to the National Comprehensive Cancer Network risk classification and prognostic factors in patients who survived several years without BCR.
Between January 2009 and December 2018, 877 patients with complete clinicopathologic and follow-up data were included. Using the Kaplan-Meier estimation, the probabilities of C-BCRFS after RP were estimated in patients who did not experience BCR at 0-4 years. C-BCRFS was analyzed according to the National Comprehensive Cancer Network risk classification and compared using the log-rank test. Prognostic factors at each year without BCR were evaluated using multivariable Cox regression analysis.
The median follow-up duration and patient age were 48 months and 67 years, respectively. As the BCR-free interval increased (baseline, 1, 2, 3, and 4 years after RP), the 5-year C-BCRFS rates improved marginally (74.8%, 83.2%, 89.1%, 93.6%, and 98.5%, respectively). However, the 5-year C-BCRFS rates in the high/very high-risk group rose from 54.0% at baseline to 67.6%, 80.3%, 88.6, and 97.8% after 1-4 years free of BCR, respectively. In patients with a BCR-free duration more than 1 year, only seminal vesicle invasion and pathological Gleason score were significant predictive factors of BCR thereafter.
In the high/very high-risk group, the C-BCRFS markedly improved as the interval without BCR increased. In patients who were BCR-free for several years, seminal vesicle invasion and pathological Gleason score were prognostic factors of continued BCRFS. This is useful not only for patient counseling but also to optimize postoperative follow-up strategies.
条件生存被定义为在已经存活一定时长的前提下后续存活的可能性。大多数前列腺癌条件生存分析在临床上并不适用，因为它们没有分析基于治疗后治愈持久性的结局。我们根据美国国立综合癌症网络风险分类以及在无生化复发（BCR）情况下存活数年的患者的预后因素，评估了前列腺癌根治性前列腺切除术（RP）后无生化复发生存（C-BCRFS）的条件概率。
纳入2009年1月至2018年12月期间877例具有完整临床病理和随访数据的患者。使用Kaplan-Meier估计法，对在0至4年未发生BCR的患者估计RP后C-BCRFS的概率。根据美国国立综合癌症网络风险分类分析C-BCRFS，并使用对数秩检验进行比较。使用多变量Cox回归分析评估每年无BCR时的预后因素。
中位随访时间和患者年龄分别为48个月和67岁。随着无BCR间隔时间增加（RP后基线、1、2、3和4年），5年C-BCRFS率略有改善（分别为74.8%、83.2%、89.1%、93.6%和98.5%）。然而，高/极高风险组的5年C-BCRFS率从基线时的54.0%分别升至无BCR 1至4年后的67.6%、80.3%、88.6%和97.8%。在无BCR持续时间超过1年的患者中，此后只有精囊侵犯和病理Gleason评分是BCR的显著预测因素。
在高/极高风险组中，随着无BCR间隔时间增加，C-BCRFS显著改善。在无BCR数年的患者中，精囊侵犯和病理Gleason评分是持续BCRFS的预后因素。这不仅对患者咨询有用，也有助于优化术后随访策略。
