Shee Kevin, Washington Samuel L, Cowan Janet E, de la Calle Claire M, Baskin Avi S, Chappidi Meera R, Escobar Domenique, Nguyen Hao G, Cooperberg Matthew R, Carroll Peter R
Department of Urology, UCSF, San Francisco, California.
Department of Epidemiology & Biostatistics, UCSF, San Francisco, California.
J Urol. 2023 Jan;209(1):198-207. doi: 10.1097/JU.0000000000002956. Epub 2022 Sep 6.
Clinical guidelines suggest that for low-grade, clinically localized prostate cancer, patients with higher volume of disease at diagnosis may benefit from definitive therapy, although the data remain unclear. Our objective was to determine associations between low-grade prostate cancer volume and outcomes in men managed with primary radical prostatectomy.
Men with cT1-2N0/xM0/x prostate cancer, prostate specific antigen at diagnosis <10 ng/mL, and Gleason grade group 1 pathology on diagnostic biopsy managed with primary radical prostatectomy were included. Outcomes were pathological upgrade at radical prostatectomy (≥Gleason grade group 2), University of California, San Francisco adverse pathology at radical prostatectomy (≥Gleason grade group 3, pT3/4, or pN1), alternate adverse pathology at radical prostatectomy (≥Gleason grade group 3, ≥pT3b, or pN1), and recurrence (biochemical failure with 2 prostate specific antigen ≥0.2 ng/mL or salvage treatment). Multivariable logistic regression models were used to estimate associations between percentage of positive cores and risk of upgrade and adverse pathology at radical prostatectomy. Multivariable Cox proportional hazards regression models were used to estimate associations between percentage of positive cores and hazard of recurrence after radical prostatectomy.
A total of 1,029 men met inclusion criteria. Multivariable logistic regression models demonstrated significant associations between percentage of positive cores and pathological upgrade (OR 1.31, 95% CI 1.1-1.57, 01), but not University of California, San Francisco adverse pathology at radical prostatectomy (84); percentage of positive cores was negatively associated with alternate adverse pathology (OR 0.67, 95% CI 0.48-0.93, 02). Multivariable Cox regression models demonstrated no association between percentage of positive cores and hazard of recurrence after radical prostatectomy (11).
In men with Gleason grade group 1 prostate cancer, tumor volume may be associated with upgrading at radical prostatectomy, but not more clinically significant outcomes of adverse pathology or recurrence.
临床指南表明，对于低级别、临床局限性前列腺癌，诊断时疾病体积较大的患者可能从确定性治疗中获益，尽管数据仍不明确。我们的目的是确定低级别前列腺癌体积与接受原发性根治性前列腺切除术男性患者预后之间的关联。
纳入cT1-2N0/xM0/x前列腺癌、诊断时前列腺特异性抗原<10 ng/mL且诊断性活检Gleason分级组为1级病理并接受原发性根治性前列腺切除术的男性患者。结局指标为根治性前列腺切除术中的病理升级（≥Gleason分级组2级）、加利福尼亚大学旧金山分校根治性前列腺切除术中的不良病理（≥Gleason分级组3级、pT3/4或pN1）、根治性前列腺切除术中的其他不良病理（≥Gleason分级组3级、≥pT3b或pN1）以及复发（两次前列腺特异性抗原≥0.2 ng/mL时的生化失败或挽救性治疗）。采用多变量逻辑回归模型估计阳性核心百分比与根治性前列腺切除术中病理升级和不良病理风险之间的关联。采用多变量Cox比例风险回归模型估计阳性核心百分比与根治性前列腺切除术后复发风险之间的关联。
共有1029名男性符合纳入标准。多变量逻辑回归模型显示阳性核心百分比与病理升级之间存在显著关联（比值比1.31，95%置信区间1.1-1.57，P<0.01），但与加利福尼亚大学旧金山分校根治性前列腺切除术中的不良病理无关（P=0.84）；阳性核心百分比与其他不良病理呈负相关（比值比0.67，95%置信区间0.48-0.93，P=0.02）。多变量Cox回归模型显示阳性核心百分比与根治性前列腺切除术后复发风险之间无关联（P=0.11）。
在Gleason分级组为1级的前列腺癌男性患者中，肿瘤体积可能与根治性前列腺切除术中的病理升级有关，但与不良病理或复发等更具临床意义的结局无关。
