Suh Jungyo, Jeong In Gab, Jeon Hwang Gyun, Jeong Chang Wook, Lee Sangchul, Jeon Seong Soo, Byun Seok-Soo, Kwak Cheol, Ahn Hanjong
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cancer Res Treat. 2024 Jul;56(3):885-892. doi: 10.4143/crt.2023.1264. Epub 2024 Jan 5.
Pathologic T3b (pT3b) prostate cancer, characterized by seminal vesicle invasion (SVI), exhibits variable oncological outcomes post-radical prostatectomy (RP). Identifying prognostic factors is crucial for patient-specific management. This study investigates the impact of bilateral SVI on prognosis in pT3b prostate cancer.
We evaluated the medical records of a multi-institutional cohort of men who underwent RP for prostate cancer with SVI between 2000 and 2012. Univariate and multivariable analyses were performed using Kaplan-Meier analysis and covariate-adjusted Cox proportional hazard regression for biochemical recurrence (BCR), clinical progression (CP), and cancer-specific survival (CSS).
Among 770 men who underwent RP without neo-adjuvant treatment, median follow-up was 85.7 months. Patients with bilateral SVI had higher preoperative prostate-specific antigen levels and clinical T category (all p < 0.001). Extracapsular extension, tumor volume, lymph node metastasis (p < 0.001), pathologic Gleason grade group (p < 0.001), and resection margin positivity (p < 0.001) were also higher in patients with bilateral SVI. The 5-, 10-, and 15-year BCR-free survival rates were 23.9%, 11.7%, and 8.5%; CP-free survival rates were 82.8%, 62.5%, and 33.4%; and CSS rates were 96.4%, 88.1%, and 69.5%, respectively. The bilateral SVI group demonstrated significantly lower BCR-free survival rates, CP-free survival rates, and CSS rates (all p < 0.001). Bilateral SVI was independently associated with BCR (hazard ratio, 1.197; 95% confidence interval, p=0.049), CP (p=0.022), and CSS (p=0.038) in covariate-adjusted Cox regression.
Bilateral SVI is a robust, independent prognostic factor for poor oncological outcomes in pT3b prostate cancer.
病理T3b（pT3b）期前列腺癌以精囊侵犯（SVI）为特征，根治性前列腺切除术（RP）后其肿瘤学结局存在差异。识别预后因素对患者的个体化管理至关重要。本研究探讨双侧SVI对pT3b期前列腺癌预后的影响。
我们评估了2000年至2012年间因前列腺癌合并SVI接受RP的多机构队列男性患者的病历。采用Kaplan-Meier分析以及针对生化复发（BCR）、临床进展（CP）和癌症特异性生存（CSS）的协变量调整Cox比例风险回归进行单因素和多因素分析。
在770例未接受新辅助治疗而接受RP的男性患者中，中位随访时间为85.7个月。双侧SVI患者术前前列腺特异性抗原水平和临床T分期更高（均p<0.001）。双侧SVI患者的包膜外侵犯、肿瘤体积、淋巴结转移（p<0.001）、病理Gleason分级组（p<0.001）以及手术切缘阳性率（p<0.001）也更高。5年、10年和15年无BCR生存率分别为23.9%、11.7%和8.5%；无CP生存率分别为82.8%、62.5%和33.4%；CSS率分别为96.4%、88.1%和69.5%。双侧SVI组的无BCR生存率、无CP生存率和CSS率显著更低（均p<0.001）。在协变量调整的Cox回归分析中，双侧SVI与BCR（风险比，1.197；95%置信区间，p=0.049）、CP（p=0.022）和CSS（p=0.038）独立相关。
双侧SVI是pT3b期前列腺癌肿瘤学结局不良的一个可靠的独立预后因素。
