Catalona W J, Miller D R, Kavoussi L R
Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri.
J Urol. 1988 Sep;140(3):540-3. doi: 10.1016/s0022-5347(17)41713-7.
To determine the natural history of clinically understaged prostatic cancer patients who were followed without adjuvant therapy for at least 6 years after radical prostatectomy we reviewed the clinical courses of 21 patients (1 with clinical stage A and 20 with clinical stage B disease). All patients underwent radical retropubic prostatectomy and 9 had pathological stage C disease (6 with capsular penetration only and 3 with seminal vesicle invasion). A total of 12 patients had pathological stage D1 disease by virtue of positive nodes on permanent sections after frozen sections were read as negative. Among the patients with pathological stage C disease 67 per cent were free of recurrence 6 years after radical prostatectomy. Of the patients with seminal vesicle invasion 33 per cent had recurrence compared to 17 per cent of those with capsular penetration only. Among the 12 stage D1 cancer patients 75 per cent were free of recurrence at 6 years. In both groups patients who were followed beyond 7 years had a diminished survival free of tumor owing to late tumor recurrences. The results indicate that the intermediate survival rates free of tumor in patients with clinically understaged A or B prostatic cancer are remarkably good without adjuvant therapy. However, survival without recurrence appears to decrease after 7 years. All patients who failed treatment did so distantly; no patient failed with local recurrence alone. These results may be important in the evaluation of adjuvant therapy protocols currently under investigation for patients with clinically understaged prostate cancer.
为了确定根治性前列腺切除术后未接受辅助治疗且随访至少6年的临床分期过低的前列腺癌患者的自然病程，我们回顾了21例患者的临床病程（1例临床分期为A期，20例临床分期为B期）。所有患者均接受了耻骨后根治性前列腺切除术，9例患者病理分期为C期疾病（6例仅侵犯包膜，3例侵犯精囊）。共有12例患者因冰冻切片报告为阴性但永久切片显示淋巴结阳性而病理分期为D1期疾病。在病理分期为C期疾病的患者中，67%在根治性前列腺切除术后6年无复发。在侵犯精囊的患者中，33%出现复发，而仅侵犯包膜的患者中这一比例为17%。在12例D1期癌症患者中，75%在6年时无复发。在两组中，随访超过7年的患者由于肿瘤晚期复发，无瘤生存率降低。结果表明，临床分期过低的A或B期前列腺癌患者在未接受辅助治疗的情况下，无瘤生存的中期生存率非常好。然而，7年后无复发的生存率似乎有所下降。所有治疗失败的患者均出现远处转移；没有患者仅出现局部复发。这些结果对于评估目前正在研究的针对临床分期过低的前列腺癌患者的辅助治疗方案可能具有重要意义。
