Hoeh Benedikt, Flammia Rocco S, Hohenhorst Lukas, Sorce Gabriele, Chierigo Francesco, Tian Zhe, Saad Fred, Gallucci Michele, Briganti Alberto, Terrone Carlo, Shariat Shahrokh F, Graefen Markus, Tilki Derya, Kluth Luis A, Mandel Philipp, Becker Andreas, Chun Felix K H, Karakiewicz Pierre I
Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montréal Health Center, Montréal, Canada.
Prostate. 2022 May;82(6):687-694. doi: 10.1002/pros.24313. Epub 2022 Feb 21.
The pathological stage of prostate cancer with high-risk prostate-specific antigen (PSA) levels, but otherwise favorable and/or intermediate risk characteristics (clinical T-stage, Gleason Grade group at biopsy [B-GGG]) is unknown. We hypothesized that a considerable proportion of such patients will exhibit clinically meaningful GGG upgrading or non-organ confined (NOC) stage at radical prostatectomy (RP).
Within the Surveillance, Epidemiology, and End Results database (2010-2015) we identified RP-patients with cT1c-stage and B-GGG1, B-GGG2, or B-GGG3 and PSA 20-50 ng/ml. Rates of GGG4 or GGG5 and/or rates of NOC stage (≥ pT3 and/or pN1) were analyzed. Subsequently, separate univariable and multivariable logistic regression models tested for predictors of NOC stage and upgrading at RP.
Of 486 assessable patients, 134 (28%) exhibited B-GGG1, 209 (43%) B-GGG2, and 143 (29%) B-GGG3, respectively. The overall upgrading and NOC rates were 11% and 51% for a combined rate of upgrading and/or NOC stage of 53%. In multivariable logistic regression models predicting upgrading, only B-GGG3 was an independent predictor (odds ratio [OR]: 5.29; 95% confidence interval [CI]: 2.21-14.19; p < 0.001). Conversely, 33%-66% (OR: 2.36; 95% CI: 1.42-3.95; p = 0.001) and >66% of positive biopsy cores (OR: 4.85; 95% CI: 2.84-8.42; p < 0.001), as well as B-GGG2 and B-GGG3 were independent predictors for NOC stage (all p ≤ 0.001).
In cT1c-stage patients with high-risk PSA baseline, but low- to intermediate risk B-GGG, the rate of upgrading to GGG4 or GGG5 is low (11%). However, NOC stage is found in the majority (51%) and can be independently predicted with percentage of positive cores at biopsy and B-GGG.
前列腺癌患者前列腺特异性抗原（PSA）水平高，但其他方面具有有利和/或中等风险特征（临床T分期、活检时Gleason分级组[B-GGG]），其病理分期尚不清楚。我们假设，相当一部分此类患者在根治性前列腺切除术（RP）时会出现具有临床意义的GGG升级或非器官局限性（NOC）分期。
在监测、流行病学和最终结果数据库（2010 - 2015年）中，我们确定了cT1c期、B-GGG1、B-GGG2或B-GGG3且PSA为20 - 50 ng/ml的RP患者。分析了GGG4或GGG5的发生率以及NOC分期（≥pT3和/或pN1）的发生率。随后，分别采用单变量和多变量逻辑回归模型测试RP时NOC分期和升级的预测因素。
在486例可评估患者中，分别有134例（28%）表现为B-GGG1，209例（43%）表现为B-GGG2，143例（29%）表现为B-GGG3。升级和NOC的总体发生率分别为11%和51%，升级和/或NOC分期的合并发生率为53%。在预测升级的多变量逻辑回归模型中，只有B-GGG3是独立预测因素（比值比[OR]：5.29；95%置信区间[CI]：2.21 - 14.19；p < 0.001）。相反，33% - 66%的阳性活检核心（OR：2.36；95% CI：1.42 - 3.95；p = 0.001）以及>66%的阳性活检核心（OR：4.85；95% CI：2.84 - 8.42；p < 0.001），以及B-GGG2和B-GGG3是NOC分期的独立预测因素（所有p≤0.001）。
在PSA基线高风险但B-GGG低至中等风险的cT1c期患者中，升级到GGG4或GGG5的发生率较低（11%）。然而，大多数患者（51%）存在NOC分期，并且可以通过活检时阳性核心的百分比和B-GGG进行独立预测。
