Sasaki Takeshi, Ebara Shin, Tatenuma Tomoyuki, Ikehata Yoshinori, Nakayama Akinori, Kawase Makoto, Toide Masahiro, Yoneda Tatsuaki, Sakaguchi Kazushige, Teishima Jun, Makiyama Kazuhide, Kitamura Hiroshi, Saito Kazutaka, Koie Takuya, Koga Fumitaka, Urakami Shinji, Inoue Takahiro
Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
World J Urol. 2024 Mar 14;42(1):152. doi: 10.1007/s00345-024-04864-y.
There are no definitive prognostic factors for patients with pathological Grade Group 5 (pGG 5) prostate cancer (PCa) undergoing robot-associated radical prostatectomy (RARP). This study aimed to explore the prognostic factors among patients with pGG 5 PCa in a large Japanese cohort (MSUG94).
This retrospective, multi-institutional cohort study was conducted between 2012 and 2021 at ten centers in Japan and included 3195 patients. Patients with clinically metastatic PCa (cN1 or cM1) and those receiving neoadjuvant and/or adjuvant therapy were excluded. Finally, 217 patients with pGG5 PCa were analyzed.
The median follow-up period was 28.0 months. The 3- and 5-year biochemical recurrence-free survival (BCRFS) rates of the overall population were 66.1% and 57.7%, respectively. The optimal threshold value (47.2%) for the percentage of positive cancer cores (PPCC) with any GG by systematic biopsy was chosen based on receiver operating characteristic curve analysis. Univariate analysis revealed that the prostate-specific antigen level at diagnosis, pT, pN, positive surgical margins (PSMs), lymphovascular invasion, and PPCC were independent prognostic factors for BCRFS. A multivariate analysis revealed that PSMs and PPCC were independent prognostic factors for BCRFS. Using these two predictors, we stratified BCRFS, metastasis-free survival (MFS), and castration-resistant PCa-free survival (CRPC-FS) among patients with pGG 5 PCa.
The combination of PSMs and PPCC may be an important predictor of BCRFS, MFS, and CRPC-FS in patients with pGG 5 PCa undergoing RARP.
对于接受机器人辅助根治性前列腺切除术（RARP）的病理5级组（pGG 5）前列腺癌（PCa）患者，目前尚无明确的预后因素。本研究旨在探讨日本大型队列（MSUG94）中pGG 5 PCa患者的预后因素。
本回顾性、多机构队列研究于2012年至2021年在日本的10个中心进行，纳入3195例患者。排除临床转移性PCa（cN1或cM1）患者以及接受新辅助和/或辅助治疗的患者。最终，对217例pGG5 PCa患者进行了分析。
中位随访期为28.0个月。总体人群的3年和5年无生化复发生存率（BCRFS）分别为66.1%和57.7%。根据受试者工作特征曲线分析，选择系统活检中任何GG级阳性癌灶百分比（PPCC）的最佳阈值（47.2%）。单因素分析显示，诊断时的前列腺特异性抗原水平、pT、pN、手术切缘阳性（PSM）、淋巴血管侵犯和PPCC是BCRFS的独立预后因素。多因素分析显示，PSM和PPCC是BCRFS的独立预后因素。使用这两个预测指标，我们对pGG 5 PCa患者的BCRFS、无转移生存率（MFS）和去势抵抗性前列腺癌无进展生存率（CRPC-FS）进行了分层。
PSM和PPCC的组合可能是接受RARP的pGG 5 PCa患者BCRFS、MFS和CRPC-FS的重要预测指标。
