Grygorenko V, Afanasiev Ye, Danylets R, Vikarchuk M, Kosyuchno M, Pasichnyk S
State Institution "Institute of Urology named after academician O.F. Vozyanov of the National Academy of Medical Sciences of Ukraine", Kyiv 04053, Ukraine.
Department of Urology of Medical Center "Dobrobut-Clinic", Kyiv 02000, Ukraine.
Exp Oncol. 2022 May;44(1):67-74. doi: 10.32471/exp-oncology.2312-8852.vol-44-no-1.17436.
Prostate cancer (PCa) is the second most frequently diagnosed cancer in males worldwide and placed fifth in cancer mortality among males. Between 14-24% of PCa patients have newly diagnosed advanced stages, which paradoxically has remained stable over time.
To estimate and compare long-term radical prostatectomy (RP) oncologic outcomes in patients with clinically locally advanced prostate cancer (LAPCa), to determine the prognostic significance of common clinical-pathological parameters.
The study included 105 patients with LAPCa who underwent RP with extended pelvic lymphadenectomy between September 2003 - April 2015. Kaplan - Meier method was used for calculating biochemical recurrence- (BRFS), progression-free- (PFS), overall (OS), and prostate cancer-specific survival (PCSS) rates. Analyses of features associated with outcomes were conducted using Cox proportional hazards regression model.
Patients from cT3b group had worse PFS, OS and PCSS rates in comparison with cT3a, while there was no significant difference in BRFS rates. Preoperative serum prostate-specific antigen level (hazard ratio (HR) 1.023, 95% confidence interval (CI): 1.014-1.033, p < 0.001), pT3a (HR 3,027, 95% CI: 1.449-7.096, p < 0.01), pT3b (HR 2.792, 95% CI: 1.133-6.881, p < 0.05) pT4 stage (HR 31.12, 95% CI: 7.646-126.6 p < 0.001) and positive lymph nodes status (HR 6.503, 95% CI: 3.190-13.25, p < 0.001) were significant factors in BRFS. Preoperative serum prostate-specific antigen level (HR 1.018, 95% CI: 1.007-1.030, p = 0.001) and positive lymph nodes status (HR 3.191, 95% CI: 1.672-6.088, p < 0.001) were significant factors in PFS and PCSS.
RP as the initial treatment option of multimodal therapy in the management of LAPCa patients demonstrates encouraging oncologic outcomes. Patients from the cT3b group had the worse rates of PFS, OS, and PCSS in comparison with the cT3a group. Heterogeneity of LAPCa patients' outcomes reflects the insufficiency of the existing clinical risk classification for the prediction of systemic progression and cancer-specific survival.
前列腺癌（PCa）是全球男性中第二常见的诊断癌症，在男性癌症死亡率中排名第五。14% - 24%的PCa患者初诊时为晚期，矛盾的是，这一比例长期以来一直保持稳定。
评估并比较临床局部晚期前列腺癌（LAPCa）患者长期根治性前列腺切除术（RP）的肿瘤学结局，以确定常见临床病理参数的预后意义。
本研究纳入了105例LAPCa患者，他们于2003年9月至2015年4月期间接受了RP联合扩大盆腔淋巴结清扫术。采用Kaplan - Meier法计算生化复发率（BRFS）、无进展生存率（PFS）、总生存率（OS）和前列腺癌特异性生存率（PCSS）。使用Cox比例风险回归模型对与结局相关的特征进行分析。
与cT3a组相比，cT3b组患者的PFS、OS和PCSS率更差，而BRFS率无显著差异。术前血清前列腺特异性抗原水平（风险比（HR）1.023，95%置信区间（CI）：1.014 - 1.033，p < 0.001）、pT3a（HR 3.027，95% CI：1.449 - 7.096，p < 0.01）、pT3b（HR 2.792，95% CI：1.133 - 6.881，p < 0.05）、pT4期（HR 31.12，95% CI：7.646 - 126.6，p < 0.001）和阳性淋巴结状态（HR 6.503，95% CI：3.190 - 13.25，p < 0.001）是BRFS的显著因素。术前血清前列腺特异性抗原水平（HR 1.018，95% CI：1.007 - 1.030，p = 0.001）和阳性淋巴结状态（HR 3.191，95% CI：1.672 - 6.088，p < 下0.001）是PFS和PCSS的显著因素。
RP作为LAPCa患者多模式治疗的初始治疗选择，显示出令人鼓舞的肿瘤学结局。与cT3a组相比，cT3b组患者的PFS、OS和PCSS率更差。LAPCa患者结局的异质性反映了现有临床风险分类在预测全身进展和癌症特异性生存方面的不足。
