Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126, Verona, Italy.
Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Aging Clin Exp Res. 2023 Sep;35(9):1881-1889. doi: 10.1007/s40520-023-02466-z. Epub 2023 Jun 19.
This study aimed to assess more clinical and pathological factors associated with prostate cancer (PCa) progression in high-risk PCa patients treated primarily with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) in a tertiary referral center.
In a period ranging from January 2013 to October 2020, RARP and ePLND were performed on 180 high-risk patients at Azienda Ospedaliera Universitaria Integrata of Verona (Italy). PCa progression was defined as biochemical recurrence/persistence and/or local recurrence and/or distant metastases. Statistical methods evaluated study endpoints, including Cox's proportional hazards, Kaplan-Meyer survival curves, and binomial logistic regression models.
The median age of included patients was 66.5 [62-71] years. Disease progression occurred in 55 patients (30.6%), who were more likely to have advanced age, palpable tumors, and unfavorable pathologic features, including high tumor grade, stage, and pelvic lymph node invasion (PLNI). On multivariate analysis, PCa progression was predicted by advanced age (≥ 70 years) (HR = 2.183; 95% CI = 1.089-4377, p = 0.028), palpable tumors (HR = 3.113; 95% CI = 1.499-6.465), p = 0.002), and PLNI (HR = 2.945; 95% CI = 1.441-6.018, p = 0.003), which were associated with clinical standard factors defining high-risk PCa. Age had a negative prognostic impact on elderly patients, who were less likely to have palpable tumors but more likely to have high-grade tumors.
High-risk PCa progression was independently predicted by advanced age, palpable tumors, and PLNI, which is associated with standard clinical prognostic factors. Consequently, with increasing age, the prognosis is worse in elderly patients, who represent an unfavorable age group that needs extensive counseling for appropriate and personalized management decisions.
本研究旨在评估在意大利维罗纳综合大学附属医院（Azienda Ospedaliera Universitaria Integrata of Verona）接受机器人辅助根治性前列腺切除术（RARP）和扩展盆腔淋巴结清扫术（ePLND）治疗的高危前列腺癌（PCa）患者中，与 PCa 进展相关的更多临床和病理因素。
在 2013 年 1 月至 2020 年 10 月期间，对 180 例高危患者进行了 RARP 和 ePLND。PCa 进展定义为生化复发/持续存在和/或局部复发和/或远处转移。统计方法评估了研究终点，包括 Cox 比例风险、Kaplan-Meier 生存曲线和二项逻辑回归模型。
纳入患者的中位年龄为 66.5 [62-71] 岁。55 例患者（30.6%）发生疾病进展，这些患者更可能具有高龄、可触及的肿瘤和不良的病理特征，包括高肿瘤分级、分期和盆腔淋巴结侵犯（PLNI）。多因素分析显示，高龄（≥70 岁）（HR=2.183；95%CI=1.089-4377，p=0.028）、可触及的肿瘤（HR=3.113；95%CI=1.499-6.465，p=0.002）和 PLNI（HR=2.945；95%CI=1.441-6.018，p=0.003）预测了 PCa 进展，这些因素与定义高危 PCa 的临床标准因素相关。年龄对老年患者具有负性预后影响，这些患者不太可能有可触及的肿瘤，但更可能有高级别肿瘤。
高危 PCa 进展独立预测因素为高龄、可触及的肿瘤和 PLNI，这些因素与标准的临床预后因素相关。因此，随着年龄的增长，老年患者的预后更差，他们代表了一个不利的年龄组，需要进行广泛的咨询，以便做出适当和个性化的管理决策。
