Porcaro Antonio Benito, Bianchi Alberto, Panunzio Andrea, Gallina Sebastian, Tafuri Alessandro, Serafin Emanuele, Orlando Rossella, Mazzucato Giovanni, Vidiri Stefano, D'Aietti Damiano, Montanaro Francesca, Marafioti Patuzzo Giulia, Artoni Francesco, Baielli Alberto, Ditonno Francesco, Rizzetto Riccardo, Veccia Alessandro, Gozzo Alessandra, De Marco Vincenzo, Brunelli Matteo, Cerruto Maria Angela, Antonelli Alessandro
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, Verona 37126, Italy.
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Ther Adv Urol. 2024 Feb 11;16:17562872241229260. doi: 10.1177/17562872241229260. eCollection 2024 Jan-Dec.
Treatment outcomes in intermediate-risk prostate cancer (PCa) may be impaired by adverse pathology misclassification including tumor upgrading and upstaging. Clinical predictors of disease progression need to be improved in this category of patients.
To identify PCa prognostic factors to define prognostic groups in intermediate-risk patients treated with robot-assisted radical prostatectomy (RARP).
Data from 1143 patients undergoing RARP from January 2013 to October 2020 were collected: 901 subjects had available follow-up, of whom 479 were at intermediate risk.
PCa progression was defined as biochemical recurrence and/or local recurrence and/or distant metastases. Study endpoints were evaluated by statistical methods including Cox's proportional hazards, Kaplan-Meyer survival curves, and binomial and multinomial logistic regression models.
After a median (interquartile range) of 35 months (15-57 months), 84 patients (17.5%) had disease progression, which was independently predicted by the percentage of biopsy-positive cores ⩾ 50% and the International Society of Urological Pathology (ISUP) grade group 3 for clinical factors and by ISUP > 2, positive surgical margins and pelvic lymph node invasion for pathological features. Patients were classified into clinical and pathological groups as favorable, unfavorable (one prognostic factor), and adverse (more than one prognostic factor). The risk of PCa progression increased with worsening prognosis through groups. A significant positive association was found between the two groups; consequently, as clinical prognosis worsened, the risk of detecting unfavorable and adverse pathological prognostic clusters increased in both unadjusted and adjusted models.
The study identified factors predicting disease progression that allowed the computation of highly correlated prognostic groups. As the prognosis worsened, the risk of PCa progression increased. Intermediate-risk PCa needs more prognostic stratification for appropriate management.
中危前列腺癌（PCa）的治疗结果可能会因不良病理分类而受损，包括肿瘤升级和分期上调。这类患者疾病进展的临床预测指标需要改进。
确定PCa预后因素，以定义接受机器人辅助根治性前列腺切除术（RARP）的中危患者的预后分组。
收集了2013年1月至2020年10月期间1143例行RARP患者的数据：901例患者有可用的随访资料，其中479例为中危患者。
PCa进展定义为生化复发和/或局部复发和/或远处转移。通过Cox比例风险模型、Kaplan-Meier生存曲线以及二项式和多项逻辑回归模型等统计方法评估研究终点。
在中位（四分位间距）35个月（15 - 57个月）后，84例患者（17.5%）出现疾病进展，活检阳性核心比例≥50%和国际泌尿病理学会（ISUP）3级组为临床因素的独立预测因素，ISUP>2、手术切缘阳性和盆腔淋巴结侵犯为病理特征的独立预测因素。患者被分为临床和病理组，分别为有利、不利（一个预后因素）和不良（多个预后因素）。PCa进展风险随各组预后恶化而增加。两组之间存在显著的正相关；因此，随着临床预后恶化，在未调整和调整模型中检测到不利和不良病理预后簇的风险均增加。
该研究确定了预测疾病进展的因素，这些因素可用于计算高度相关的预后分组。随着预后恶化PCa进展风险增加。中危PCa需要更多的预后分层以进行适当管理。
