Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Department of Urology, Medical University of Graz, Auenbruggerpl. 1, 8036, Graz, Österreich Graz, Austria.
World J Urol. 2024 Apr 28;42(1):269. doi: 10.1007/s00345-024-04940-3.
The cT1a vs. cT1b substratification was introduced in 1992 but never formally tested since. We tested the discriminative ability of cT1a vs. cT1b substaging on cancer-specific survival (CSS) in contemporary incidental prostate cancer (PCa) patients.
DESIGN, SETTING AND PARTICIPANTS: Incidental (cT1a/cT1b) PCa patients were identified within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015).
Kaplan-Meier estimates, as well as uni- and multivariable Cox regression models predicted CSS at five years. Subgroup analyses addressed CSS at five years according to active vs. no local treatment (NLT) as well as Gleason score sum (GS; 6 vs. 7 vs. ≥ 8).
We identified a total of 5,155 incidental prostate cancer patients of which 3,035 (59%) were stage cT1a vs. 2,120 (41%) were stage cT1b. In all incidental PCa patients, CSS at five years was 95% (95% CI 0.94-0.96). In cT1a patients, CSS at five years was 98 vs. 90% in cT1b patients (p < 0.001). In multivariable Cox regression analyses, cT1b independently predicted 2.8-fold higher CSM than cT1a (HR 2.5, 95% CI 1.8-3.6, p < 0.001) for incidental PCa patients who underwent NLT. In subgroup analyses, cT1b represented an independent predictor of higher CSM in GS ≥ 8 (HR 3.0, 95% CI 1.4-6.2, p = 0.003), and GS 7 (HR 3.9, 95% CI 1.6-9.7 p = 0.002) patients who underwent NLT. For actively treated patients, cT1b was not independently associated with worse CSM.
The historical subclassification of cT1a vs. cT1b in incidental PCa patients displayed a strong ability to discriminate CSS in contemporary GS 7 and GS ≥ 8 patients who underwent NLT. However, no statistically significant difference was recorded in actively treated patients. In consequence, the importance of the current substage stratification predominantly applies to GS ≥ 8 patients who undergo a non-active treatment approach.
1992 年引入了 cT1a 与 cT1b 的亚分期，但此后从未进行过正式测试。我们在当代偶发前列腺癌（PCa）患者中测试了 cT1a 与 cT1b 亚分期对癌症特异性生存（CSS）的区分能力。
设计、地点和参与者：在监测、流行病学和最终结果（SEER）数据库（2004-2015 年）中确定了偶发性（cT1a/cT1b）PCa 患者。
Kaplan-Meier 估计以及单变量和多变量 Cox 回归模型预测了五年时的 CSS。亚组分析根据局部主动治疗（active treatment，AT）与无局部治疗（no local treatment，NLT）以及 Gleason 评分总和（Gleason score sum，GS；6、7、≥8）对五年时的 CSS 进行了探讨。
我们共确定了 5155 例偶发性前列腺癌患者，其中 3035 例（59%）为 cT1a 期，2120 例（41%）为 cT1b 期。在所有偶发性 PCa 患者中，五年 CSS 为 95%（95%CI 0.94-0.96）。在 cT1a 患者中，五年 CSS 为 98%，而在 cT1b 患者中为 90%（p<0.001）。在多变量 Cox 回归分析中，cT1b 独立预测接受 NLT 的偶发性 PCa 患者的 CSM 增加了 2.8 倍（HR 2.5，95%CI 1.8-3.6，p<0.001）。在亚组分析中，cT1b 是 GS≥8（HR 3.0，95%CI 1.4-6.2，p=0.003）和 GS7（HR 3.9，95%CI 1.6-9.7，p=0.002）患者接受 NLT 后更高 CSM 的独立预测因素。对于接受积极治疗的患者，cT1b 与 CSS 无显著相关性。
在接受 NLT 的当代 GS 7 和 GS≥8 偶发性 PCa 患者中，cT1a 与 cT1b 的历史亚分期显示出很强的区分 CSS 的能力。然而，在接受积极治疗的患者中，未记录到统计学上的显著差异。因此，当前亚分期分层的重要性主要适用于接受非积极治疗方法的 GS≥8 患者。
