Porcaro Antonio Benito, Bianchi Alberto, Gallina Sebastian, Panunzio Andrea, Tafuri Alessandro, Serafin Emanuele, Orlando Rossella, Mazzucato Giovanni, Ornaghi Paola Irene, Cianflone Francesco, Montanaro Francesca, Artoni Francesco, Baielli Alberto, Ditonno Francesco, Migliorini Filippo, Brunelli Matteo, Siracusano Salvatore, Cerruto Maria Angela, Antonelli Alessandro
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy.
Department of Urology, Vito Fazzi Hospital, 73110 Lecce, Italy.
Cancers (Basel). 2024 Jun 4;16(11):2137. doi: 10.3390/cancers16112137.
To assess the prognostic impact and predictors of adverse tumor grade in very favorable low- and intermediate-risk prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP).
Data of low- and intermediate PCa risk-class patients were retrieved from a prospectively maintained institutional database. Adverse tumor grade was defined as pathology ISUP grade group > 2. Disease progression was defined as a biochemical recurrence event and/or local recurrence and/or distant metastases. Associations were assessed by Cox's proportional hazards and logistic regression model.
Between January 2013 and October 2020, the study evaluated a population of 289 patients, including 178 low-risk cases (61.1%) and 111 intermediate-risk subjects (38.4%); unfavorable tumor grade was detected in 82 cases (28.4%). PCa progression, which occurred in 29 patients (10%), was independently predicted by adverse tumor grade and biopsy ISUP grade group 2, with the former showing stronger associations (hazard ratio, HR = 4.478; 95% CI: 1.840-10.895; = 0.001) than the latter (HR = 2.336; 95% CI: 1.057-5.164; = 0.036). Older age and biopsy ISUP grade group 2 were independent clinical predictors of adverse tumor grade, associated with larger tumors that eventually presented non-organ-confined disease.
In a very favorable PCa patient population, adverse tumor grade was an unfavorable prognostic factor for disease progression. Active surveillance in very favorable intermediate-risk patients is still a hazard, so molecular and genetic testing of biopsy specimens is needed.
评估接受机器人辅助根治性前列腺切除术（RARP）治疗的极低和低中危前列腺癌（PCa）患者中不良肿瘤分级的预后影响及预测因素。
从一个前瞻性维护的机构数据库中检索低中危PCa风险分级患者的数据。不良肿瘤分级定义为病理ISUP分级组>2。疾病进展定义为生化复发事件和/或局部复发和/或远处转移。通过Cox比例风险模型和逻辑回归模型评估相关性。
在2013年1月至2020年10月期间，该研究评估了289例患者，包括178例低危病例（61.1%）和111例中危受试者（38.4%）；82例（28.4%）检测到不良肿瘤分级。29例患者（10%）发生了PCa进展，不良肿瘤分级和活检ISUP分级组2独立预测了PCa进展，前者显示出比后者更强的相关性（风险比，HR = 4.478；95%CI：1.840 - 10.895；P = 0.001）（HR = 2.336；95%CI：1.057 - 5.164；P = 0.036）。年龄较大和活检ISUP分级组2是不良肿瘤分级的独立临床预测因素，与最终呈现非器官局限性疾病的较大肿瘤相关。
在极低危PCa患者群体中，不良肿瘤分级是疾病进展的不良预后因素。对极低危中危患者进行主动监测仍然存在风险，因此需要对活检标本进行分子和基因检测。
